44. Describing “Operative Burden” In Long-term Surgical Protocols for Cleft Lip/Palate: A Proof-of-concept Data-visualization Tool

PURPOSE: Cleft lip/palate repair is classically divided into three phases: the primary phase includes pre-surgical infant orthodontics (PSIO), cleft lip repair at 3 months, and cleft palate repair at 9-12 months; the second phase involves a potential speech operation at 3 years and alveolar bone grafting at 7-9 years; and the third phase includes orthognathic surgery and rhinoplasty around 15 years. Although ideal care pathways are envisioned, actual treatment often deviates from these ideals. Common deviations may include lip and palate revision, lip adhesion, fistula repair, presence/absence of PSIO depending on the practice, and different orthognathic considerations. This project proposes a novel visualization technique to clearly visualize operative burden among patients and teams. METHODS: Various visualization methods, such as flow charts and line graphs, were considered before developing a specific timeline chart. Simulated data for two hypothetical cleft treatment teams—differing in protocols, operative events, complication rates, and compliance—were created in Python (Matplotlib and Altair). The aim was to clearly display and compare the timing and quantity of operative events across teams. Operative events for each patient were placed as dots along a timeline. The initial iteration presents data by date and suggests that Team B performs more operations than Team A, but it is difficult to interpret where these differences exist. To solve this, we converted date to patient age, color-coded procedures, and stratified by different cleft phenotypes. We iterated through multiple designs and present the optimal visualization below. RESULTS: Individual and team differences were more clearly delineated. For example, it was clear that treatment of cleft lip (CL) appears to be similar between teams, but treatment of cleft lip and alveolus (CLA) differs in that Team B is performing more early rhinoplasty (yellow dots). However, it was difficult to quantify large numbers of patients in this layout. Another way to display this data is to use stacked bar charts to succinctly show the average number of interventions per patient for each phenotype. This visualization is ideal for team comparison, as it removes the clutter of individual data points. CONCLUSION: This novel visualization technique allows teams to see the operative burden placed on patients and identify trends in treatment protocols. They can then compare these trends to their ideal protocol and to the protocols of their peers. As teams often follow their patients for years and decades on end, these visualizations can prove crucial to informing cleft care. It will be important to test this visualization technique with real-world data as well as adapt these visuals in a patient facing manner so patients can understand their individual care compared to others. The stacked bar chart aggregation is easily recognizable and understood but it is not able to show the time dimension. We are working to adapt our timeline motif for aggregated statistics which will communicate average number of events and when these events occur.