Clinical Predictors Of Suboptimal Intervention Among Patients With Cleft Lip And Palate
Jeremy V. Lynn, BS, Kavitha Ranganathan, MD, Matthew H. Bageris, Alexandra O. Luby, MS, Hailey R. Tursak, R Alexander Blackwood, MD, PhD, Steven R. Buchman, MD.
University of Michigan, Ann Arbor, MI, USA.
Purpose: The acute and long-term wellbeing of patients with cleft lip and/or palate (CL/P) is impacted by the timing of cleft repair and accompanying speech and language therapy. However, clinically accessible predictors of unfavorable delays in CL/P care remain ill-defined. To mitigate health disparities and progress toward health equity, associations between patient characteristics and CL/P management must be delineated. The purpose of this study is to identify the impact of sociodemographic and health variables on the age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation in order to enable multidisciplinary cleft care teams to proactively support individuals at-risk of unfavorable delays.
Methods: A retrospective cohort study was designed and approved by the Institutional Review Board. All patients born between 2011 and 2014 who received surgical CL/P repair at our institution were included. Syndromic patients and those with systemic disease were included to identify the potential impact of comorbidities on CL/P care. Adopted patients were excluded to avoid confounding effects of delays unrelated to patient or care variables. Sociodemographic and care variables were collected and analyzed via hierarchical linear regression at p=0.05 significance (SPSS 24.0). Results were reported as number of weeks delayed relative to control (i.e. Asian versus non-Asian patients).
Results: This study included 165 patients with CL/P (Table 1). Cleft lip repair was significantly delayed for patients identifying as Asian (18-week delay, p=0.01), patients with Child Protective Services contact (19-week delay, p=0.01), patients with a significant comorbidity such as a syndrome (14-week delay, p=0.02), and patients who underwent preliminary lip adhesion surgery (19-week delay, p<0.01). Cleft palate repair was significantly delayed for patients identifying racially as Asian (19-week delay, p=0.03) and Other race (American Indian, Alaska Native, Native Hawaiian, Pacific Islander; 22-week delay, p=0.03). Preliminary speech and language evaluation was significantly delayed for patients identifying as black (55-week delay, p=0.03).
Conclusions: Timing of cleft lip repair, cleft palate repair, and primary speech and language evaluation is subject to variation which may be predicted by clinically accessible factors. By identifying race, Child Protective Services contact, and care variables as significant predictors of delayed intervention, multidisciplinary cleft care teams can proactively allocate patient support resources in a targeted fashion. This study contributes to the growing effort within the field of plastic and reconstructive surgery to identify and support patients with CL/P who are at-risk for suboptimal care. Additional studies investigating the impact of surgical delay on need for revision surgery are warranted to delineate economic benefits of timely care.
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