Time Trends and Determinants of Fistula in Cleft Patients at BC Children's Hospital, Canada: A Retrospective 18-Year Medical Chart Audit.

Objective: To examine the time trends and determinants of palatal fistula in children with different types of cleft at British Columbia's Children's Hospital between 1995 and 2012.
Methods: A total of 558 medical charts of nonsyndromic patients with cleft lip and palate were eligible for the chart review. The occurrence of primary palatal fistula was assessed at any time throughout the patient's total observation period. Three types of clefts were recorded: unilateral cleft lip and palate (ULCLP), bilateral cleft lip and palate (BLCLP), and isolated cleft palate (ICP). Cleft severity, time period of treatment, type of surgery and surgeon's experience were tested as determinants.
Results: Of all 558 patients, 228 had ULCLP, 226 had ICP, and 104 had BLCLP. The combined postoperative palatal fistula rate was 28%. The significant differences in fistula rates related to type of cleft (patients with BLCLP had the highest fistula rates), time period (rates were higher in earlier years than in later years), type of surgery (highest rates were for two-flap palatoplasty), and surgeons with less experience.
Conclusions: Almost one quarter of the patients, developed fistula, and fistula incidence declined after 2009. The higher fistula rates were determined by cleft severity, time period of treatment, type of surgery, and surgeon's experience.