Downloaded from http://journals.lww.com/plasreconsurg by BhDMf5ePHKbH4TTImqenVIu1/FN/J4kOt7Vc8BIx/q1JhtAQqP+tndAM8/WyGxen on 06/27/2020 Copyright © 2020 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. www.PRSJournal.com 61e T reatment of patients born with cleft lip and palate is focused on improving quality of life by means of reconstructing appear- ance, hearing, feeding, speech, dentition and, ultimately, psychosocial functioning. Although Disclosure: The authors have no financial interest to declare in relation to the content of this article. All sources of funds supporting the completion of this ar- ticle are under the auspices of the University of Cali- fornia, Los Angeles. Copyright © 2020 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000006905 Hi’ilani M. K. Potemra, B.S. Johnny Lin, Ph.D. Anthony A. Bertrand, M.D., M.B.A. Fransia S. De Leon, B.A. Jake A. Alford, M.D. Allison C. Hu, B.A. Libby Wilson, M.D. Justine C. Lee, M.D., Ph.D. Los Angeles, Calif. Background: Cleft lip and palate patients undergo a significant number of interventions during their childhood and adolescence. Although the inten- tion of such interventions is to improve psychosocial functioning, there exists a paucity of data on the psychosocial outcomes of the burden of care on cleft children. In this work, the long-term effects of quantity and timing of child- hood operations on teenagers with cleft lip and palate were evaluated. Methods: Cleft lip and palate patients (aged 14 to 17 years; n = 55) and an age-matched unaffected cohort (n = 14) prospectively enrolled from two institutions were administered the anger, anxiety, and depressive symptoms instruments from the Pediatric Patient-Reported Outcomes Measurement In- formation System. Total number of operations and operations stratified by age groups (0 to 7, 8 to 10, 11 to 13, and 14 to 17 years) were evaluated in relationship to instrument scores. Descriptive statistics, independent t tests, Pearson correlations, and multiple linear regression analyses were conducted. Results: No differences in overall psychosocial functioning were found between the cleft lip and palate and comparison groups. Total quantity of childhood operations did not correlate to psychosocial functioning of cleft lip and palate teenagers. How- ever, multiple linear regression analyses demonstrated that increased number of operations in the 8- to 10-year-old age range predicted increased anxiety and depres- sive symptoms in teenagers (β = 0.38, p = 0.009; and β = 0.29, p = 0.03, respectively). Conclusions: It was previously reported by the authors’ group that the 8- to 10-year- old age range is an at-risk period for psychosocial distress in children with cra- niofacial anomalies. Their current work demonstrates that increased number of operations during this time frame may result in long-term consequences in anxiety and depression in cleft lip and palate patients. (Plast. Reconstr. Surg. 146: 61e, 2020.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II. From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine; the Institute for Digital Research and Educa- tion, Department of Statistics, University of California, Los Angeles; and the Cleft Palate Program, Orthopaedic Insti- tute for Children. Received for publication July 3, 2019; accepted January 16, 2020. Presented at the 98th Annual Meeting of the American Asso- ciation of Plastic Surgeons, in Baltimore, Maryland, April 6 through 9, 2019; and the 64th Annual Meeting of the Plastic Surgery Research Council, in Baltimore, Maryland, May 2 through 5, 2019. Long-Term Effect of Multiple Operations on Psychosocial Function in Teenage Cleft Lip and Palate Patients By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to PlasticSurgery.org Dashboard, clicking “Submit CME,” and completing the form. A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. PEDIATRIC/CRANIOFACIAL