OBJECTIVES: Children with cleft palate (CP) or cleft lip and palate (CLP) may require multiple surgeries to improve their appearance and function. The objective of this study was to estimate the proportion of cleft palate surgeries identified as secondary (or revision) in patients with a diagnosis of cleft palate only or cleft lip and palate. Additional objectives included identification and analysis of patient and hospital level characteristics. METHODS: The Kids’ Inpatient Database (KID), a nationally representative sample of pediatric inpatient visits, was used for this study. Years analyzed included 2003, 2006, and 2009. Subjects were identified by International Classification of Diseases Ninth Revision (ICD-9) diagnosis of cleft palate only or cleft lip and palate. Primary surgery was defined as a surgery before three years of age with the ICD-9 procedural code ‘Correction Cleft Palate.’ Secondary surgery was defined as a surgery at age three or older with any of the following ICD-9 procedural codes: ‘Correction Cleft Palate,’ ‘Revision Cleft Palate Repair,’ ‘Closure Fistula Mouth,’ or ‘Plastic Repair Palate.’ Hospital, patient, and clinical characteristics were also examined across cohorts. All costs were adjusted to 2009 dollars using the Consumer Price Index (CPI). RESULTS: For the three years combined, 15,861 discharges for cleft palate repair were reported: 7,856 for CP only patients and 8,055 for CLP patients. Secondary surgery accounted for 28.1% (N=2,193) of palate repairs performed in children with CP only, compared to 43.5% (N=3,505) of palate repairs in children with CLP. Secondary surgery rates did not differ significantly across years. From 2003-2009, CPI-adjusted costs decreased in all cohorts except secondary surgery in CP only patients. CONCLUSIONS: Secondary surgeries represent a significant portion of cleft palate repairs performed in the United States. Children with cleft palate only have fewer secondary surgeries compared to those with cleft lip and palate.