Factors Associated With Delay in Cleft Surgery at a Tertiary Children’s Hospital in a Major US Metropolitan City

Abstract

Objective: To identify factors associated with late cleft repair at a US tertiary children’s hospital. Design: Retrospective study of children with CL/P using Children’s Hospital Los Angeles (CHLA) records. Setting: US tertiary children’s hospital. Patients/Participants: Patients undergoing primary CL or CP repair at CHLA from 2009 to 2018. Main Outcome Measures: Proportion of children who had delayed primary CL repair or CP repair using CHLA and American Cleft Palate-Craniofacial Association (ACPA) guidelines and factors associated with late surgery. Results: In total, 805 patients—503 (62.5%) who had CL repair, 302 (37.5%) CP repair—were included. Using CHLA protocol, 14.3% of patients seeking CL repair had delayed surgery. Delay was significantly associated with female gender, non-Hispanic ethnicity, Spanish primary language, government insurance, bilateral cleft, cleft lip and palate (CLP), and syndromic diagnosis. Using ACPA guidelines, 5.4% had delayed surgery. Female gender and syndromic diagnosis were significantly associated with delay and remained significant after adjustment for confounders in multivariate models. For CP repair, 60.3% of patients had delayed surgery using CHLA protocol. Cleft lip and palate diagnosis, complete cleft, syndromic diagnosis, and longer travel distance were significantly associated with delay. Using ACPA guidelines, 28.5% had delayed surgery; however, significant association with patient variables was not consistently observed. Conclusions: Delay in cleft surgery occurs most often for patients seeking CP repair and is associated with female gender, non-Hispanic ethnicity, Spanish language, government insurance, and bilateral CL, CLP, or syndromic diagnoses. Initiatives should aim to optimize cleft surgery delivery for these subpopulations.

Epidemiological, clinical and therapeutic aspects of cleft lip and palate in the Democratic Republic of Congo: about 1666 cases

“…However, variations in speci c percentages can be observed, highlighting the diversity in the anatomical presentation of CLP between different populations. The predominance of isolated cleft lip in our study is consistent with previous studies [12,13,20]. This observation suggests that cleft lips often represent the primary manifestation of the malformation.…”

Multicenter Pattern of Cleft Surgeries and Factors Associated with Late Primary Cleft Surgery in Nigeria

“…Other authors found varying relationships depending on whether it was CL alone, CP alone, or in combination. 32,33 Based on the American Cleft Palate-Craniofacial Association guideline, more than 70% of patients having repair for incomplete CP repair in this study were late compared with 49.2% for patients with incomplete CL. These findings are similar to a 2021 retrospective cohort study in a major US metropolitan city hospital by Stoneburner et al, 33 in which more than 60.0% of children with CP were delayed for repair beyond 18 months of age based on institutional guidelines.…”

Exploring Delay to Follow-Up in a Rural Multidisciplinary Cleft Clinic

“…Demographic risk factors for delay of key treatment points have been investigated in the literature. Lower SES (and proxy measurements of such) and non-White race have been shown to be associated with delay of primary lip or palate repair, alveolar bone grafting, and initial referral by a speech specialist 11,12,26–29 …”

“…Lower SES (and proxy measurements of such) and non-White race have been shown to be associated with delay of primary lip or palate repair, alveolar bone grafting, and initial referral by a speech specialist. 11,12,[26][27][28][29] Interestingly, almost all of these studies have been conducted in urban US populations or in developing countries, whereas rural populations have seldom been studied. As a result, the above risk factor relationships are not as well established in these populations.…”