{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:42:07Z","timestamp":1788432127629,"version":"build-2803163510"},"reference-count":43,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T00:00:00Z","timestamp":1634515200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Higher rates of postoperative complication following cleft lip or palate repair have been documented in low resource settings, but their causes remain unclear. This study sought to delineate patient, surgeon, and care environment factors in cleft complications in a low-income country.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective outcomes study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Comprehensive Cleft Care Center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Candidate patients presenting for cleft lip or palate repair or revision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Patient anthropometric, nutritional, environmental and peri- and post-operative care factors were collected. Post-operative evaluation occurred at standard 1-week and 2-month postoperative intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Complication was defined as fistula, dehiscence and\/or infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 408 patients enrolled, 380 (93%) underwent surgery, of which 208 (55%) underwent lip repair (124) or revision (84), and 178 (47%) underwent palate repair (96) or revision (82). 322 (85%) were evaluated 1 week and 166 (44%) 2 months postoperatively. 50(16%) complications were identified, including: 25(8%) fistulas, 24(7%) dehiscences, 17(5%) infections. Mid-upper arm circumference (MUAC) \u226412.5\u2005cm was associated with dehiscence after primary lip repair (OR\u2009=\u200928, p\u2009=\u20090.02). Leukocytosis \u226511,500 on pre-operative evaluation was associated with dehiscence (OR\u2009=\u20092.51, p\u2009=\u20090.04) or palate revision fistula (OR\u2009=\u200964, p\u2009&lt;\u20090.001). Surgeons who performed fewer previous-year palate repairs had higher likelihood of palate complications, (OR\u2009=\u20093.03, p\u2009=\u20090.01) although there was no difference in complication rate with years of surgeon experience or duration of surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multiple patient, surgeon, and perioperative factors are associated with higher rates of complication in a low-resource setting, and are potentially modifiable to reduce complications following cleft surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656211046810","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:27:47Z","timestamp":1634603267000},"page":"1452-1460","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Predictors of Complication Following Cleft Lip and Palate Surgery in a Low-Resource Setting: A Prospective Outcomes Study in Nicaragua"],"prefix":"10.1177","volume":"59","author":[{"given":"Marco A.","family":"Swanson","sequence":"first","affiliation":[{"name":"School of Medicine, Case Western Reserve University, Cleveland, OH"},{"name":"Operation Smile International, Virginia Beach, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1340-3760","authenticated-orcid":false,"given":"Allyn","family":"Auslander","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University of Southern California, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana","family":"Morales","sequence":"additional","affiliation":[{"name":"Children's Hospital Los Angeles, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8993-4314","authenticated-orcid":false,"given":"Breanna","family":"Jedrzejewski","sequence":"additional","affiliation":[{"name":"School of Medicine, Oregon Health and Science University, Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"William P.","family":"Magee","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University of Southern California, Los Angeles, CA"},{"name":"Children's Hospital Los Angeles, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Siu","sequence":"additional","affiliation":[{"name":"Operaci\u00f3n Sonrisa Nicaragua, Managua, Nicaragua"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Ayala","sequence":"additional","affiliation":[{"name":"Operation Smile International, Virginia Beach, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7112-8114","authenticated-orcid":false,"given":"Jordan W.","family":"Swanson","sequence":"additional","affiliation":[{"name":"Children's Hospital Los Angeles, Los Angeles, CA"},{"name":"Operation Smile International, Virginia Beach, VA"},{"name":"Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,10,18]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/0189-6725.125447"},{"key":"e_1_3_2_3_1","unstructured":"ACS National Surgical Quality Improvement Program. 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