Services for cleft lip and palate. Surgical caseload is only one variable that influences outcome

The surgical care of cleft lip and palate patients in England and Wales

The results of a postal survey in 1992 of surgeons in England and Wales undertaking primary repairs for babies born with cleft lip and palate are presented. 64 plastic surgeons undertaking primary cleft repairs were identified. The majority of cleft surgeons were low volume operators undertaking 10 or less lip repairs annually. Low volume operators were less likely to attend joint disciplinary clinics than high volume operators and those that did attended clinics with fewer specialities represented. None of the low volume operators collected standardised records for their patients. The recommendations of the Royal College of Surgeons of England for centralisation of cleft care in England and Wales on a regional basis and a minimum case-load per surgeon of 30 new cases per year are discussed.