Digital communication post-cleft surgery: challenges and clinical predictors

The surgical management of cleft lip and palate requires complex postoperative follow-up, necessitating responsive multidisciplinary coordination. Although secure messaging (PEC - Patient Electronic Communication) has established itself as an essential tool for continuity of care, its specific use and the actual concerns of families in this context remained poorly documented until now. This retrospective study, conducted among 109 patients followed in a paediatric referral centre in 2024, aimed to decipher the volume, recurrent themes and clinical predictors of these electronic communications.

The central objective was to identify how surgical history, the type of procedure and the occurrence of complications influence the nature of the exchanges. The authors analysed whether the accumulated surgical burden — including the number of previous procedures for clefts, alveolar bone grafts or velopharyngeal insufficiencies — correlates with the frequency of messages and their themes (wound care, nutrition, aesthetics). By mapping these interactions, the study seeks to provide concrete data to optimise therapeutic education and anticipate patients' digital needs in order to improve overall satisfaction and clinical outcomes.

Methodology for the analysis of secure communications (PEC)

This retrospective mixed-methods study, conducted in 2024 at a tertiary paediatric hospital (Children's Hospital Colorado), analysed the secure electronic communications (PEC) of patients who underwent surgery for a cleft lip or palate (primary repair or revision).

The cohort and the data include:

• Population: 109 patients included, of whom 98 (89.9%) generated a total of 260 messages.
• Analysis criteria: Message volume and themes (nutrition, wound care, follow-up, aesthetics, psychosocial support) during the pre- and postoperative periods.
• Predictive variables: Demographics, procedure type (primary vs revision), surgical history (clefts, alveolar grafts, oronasal fistulae, velopharyngeal insufficiency) and complications occurring within 30 days.
• Comparison groups: Patients were stratified according to the nature of the procedure (lip vs palate) and the complexity of their previous surgical history.

Statistical analysis was based on the identification of recurring themes and the calculation of correlations (r coefficients) between clinical factors and message content. Differences in length of stay and message frequency were validated with a significance level of p < 0.05.

Communication volume and themes

Of the 109 patients included in the study, 89.9% (n=98) used secure messaging, generating a total of 260 electronic communications (PEC). Beyond logistical issues, the thematic analysis reveals a predominance of concerns related to immediate care and function.

Impact of surgical history and complexity

The study highlights a positive correlation between the total number of previous surgeries (cleft lip and palate, alveolar bone graft, oronasal fistula, velopharyngeal insufficiency) and the overall volume of messages (r=0.31; p=0.002). This surgical burden specifically influences certain themes:

• Wound care: r=0.38 (p<0.001).
• Pain: r=0.27 (p=0.006).
• Oronasal fistula: r=0.28 (p=0.005).
• Aesthetics: r=0.24 (p=0.013).

The type of initial procedure also dictates the nature of the concerns. A more extensive history of labial surgeries is correlated with messages regarding wound care (r=0.31; p=0.002) and aesthetics (r=0.26; p=0.011). Conversely, a history of palatal surgeries is linked to fears of oronasal fistula (r=0.29; p=0.004).

Comparisons between primary surgeries and revisions

The data show a clear distinction between initial procedures and revisions, both clinically and in terms of communication:

• Length of stay: Primary repairs result in significantly longer hospital stays than revisions, whether for the lip (mean difference = 1.13 days; p<0.001) or the palate (mean difference = 0.56 days; p=0.011).
• Psychosocial support: Patients undergoing palate revision send significantly more messages regarding psychosocial and emotional support compared to all other groups (mean difference = 0.125; p<0.05).

Predictive factors: complications and age

The occurrence of complications within 30 days postoperatively is associated with an increase in messages regarding oronasal fistulas (r=0.26; p=0.009) and aesthetic concerns (r=0.20; p=0.040). Finally, the patient's age at the time of surgery shows a specific positive correlation with queries about dental problems (r=0.31; p=0.002).

Predicting anxiety: surgical burden as an indicator

With nearly 90% of patients active on secure messaging, digital communication is becoming a pillar of follow-up in cleft surgery. The data from this study show that the volume of exchanges does not decrease with patient experience; on the contrary, the number of previous procedures is positively correlated with the volume of messages (r=0.31), particularly regarding wound care (r=0.38) and aesthetics. The more complex the surgical pathway becomes, the more the need for technical and aesthetic reassurance intensifies.

The themes of the messages vary depending on the procedure: palatal revisions trigger a significantly higher demand for psychosocial support, whereas increasing age shifts the focus towards dental issues (r=0.31). Feeding remains the primary topic of inquiry excluding logistics (16%), confirming that postoperative nutritional management remains the major daily challenge for families.

Although this is the first study characterising these exchanges, its retrospective single-centre setting requires validation in larger cohorts. Nevertheless, it provides a precise mapping of needs: 30-day complications almost systematically direct messages towards oronasal fistulae and aesthetics. For the practitioner, these results suggest that patients who have undergone multiple surgeries paradoxically require more intensive preparation, as their surgical history does not mitigate their specific communication needs.

Summary of results

This study conducted on 109 patients demonstrates that 89.9% of families actively use secure messaging, generating 260 communications dominated by nutrition (16.0%) and wound care (12.5%). The overall volume of messages and concerns related to fistulas or aesthetics are positively correlated with the number of previous interventions (r=0.31, p=0.002) and the 30-day complication history (r=0.26).

In practical terms, for the practitioner:

• Adjust your coordination time: Anticipate a greater administrative and reassurance workload for multi-operated patients, whose surgical burden statistically increases the number of enquiries regarding aesthetic and functional outcomes.
• Personalise therapeutic education: Target advice on nutrition and healing for primary repairs, while specifically warning patients undergoing palatal revisions about the risks of fistula (r=0.29).
• Integrate a psychosocial component: Systematically reinforce emotional support for families affected by cleft palate revisions, with this group expressing significantly higher distress and support needs (p < 0.05).

Technical glossary of the study

Patient Electronic Communication (PEC): Secure electronic communication system (messaging) used by patients or their families to interact with the healthcare team, promoting engagement and continuity of postoperative care.

Oronasal fistula: Abnormal communication between the oral and nasal cavities. In this study, concerns regarding this complication are significantly correlated with a history of palatal surgeries and complications occurring within 30 days.

Velopharyngeal insufficiency (VPI): Dysfunction of the closure between the soft palate and the pharynx. VPI repair is identified as one of the cleft-related surgeries increasing the postoperative communication burden.

Alveolar bone graft: Surgical procedure aimed at restoring the continuity of the maxillary ridge. The study shows that this surgical history is positively correlated with a higher overall volume of messages.

Primary repair vs Revision: Distinction between the initial surgery (lip or palate) and subsequent corrective procedures. Primary repairs are associated with longer hospital stays, whereas palate revisions generate more messages related to psychosocial support.

Secure messaging: Encrypted digital communication platform enabling the exchange of health data (clinical topics, wound photos) between the patient and the tertiary hospital.

Information intended for healthcare professionals. This content may contain errors or truncated summaries. We recommend always verifying with the original source article. Delynov disclaims all liability regarding the use of this information. This document is not intended for patients or the general public.