Defining the Ideal Patient Population for Ambulatory Cleft Repair with Uplift Modeling

Objective: The utilization of ambulatory surgical centers (ASC) for cleft lip repair is increasing to reduce the costs associated with providing healthcare in the United States. The purpose of this study was to define the... [ view full abstract ]

Objective: The utilization of ambulatory surgical centers (ASC) for cleft lip repair is increasing to reduce the costs associated with providing healthcare in the United States. The purpose of this study was to define the patient population appropriate for ambulatory cleft repair with uplift modeling, a predictive analytics technique.

Methods: Pediatric patients who underwent primary repair procedures for cleft lip were identified in the 2007-2011 California Healthcare Cost and Utilization Project State Inpatient Database (HCUP SID) and State Ambulatory Surgery and Services Database (HCUP SASD). The two model uplift approach was utilized using multivariate logistic regressions fit to assess the effect of ASCs and patient and procedure characteristics on mortality and 30-day readmission rates.

Results: Of the 2881 cleft lip repairs, 83% were conducted in inpatient facilities and 17% in ASCs. Outcomes for ASC repairs were consistent with inpatient repairs. There were no mortalities in either cohort and 30-day readmission rates were 2.01% and 1.93% for ASC repairs and inpatient repairs, respectively. Uplift modeling predicts approximately 40% of patients would have benefit from an ASC repair and an ASC repair would have had no effect on the remaining 60%. Patients likely to benefit from an ASC repair were more likely younger than 1-year-old, non-syndromic, not have a respiratory or neurologic diagnosis, have less number of procedures, and to have undergone an isolated cleft lip repair.

Conclusion: Targeting patients younger than 1-year-old, non-syndromic, with no respiratory or neurologic diagnosis for ASC cleft lip repair may be a safe and cost-saving endeavor.