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Racial and Ethnic Disparities in Primary Cleft Lip and Cleft Palate Repair
Mary Carter Mullen1, Flora Yan1, Marvella E Ford1
12345Medical University of South Carolina, Charleston, SC, USA.
Insights
Racial and ethnic disparities exist in cleft lip and cleft palate repair timing and outcomes. Non-White children, particularly Asian patients, experienced delayed surgical repair, and Black and Hispanic children faced higher readmission rates.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Health Disparities Research
Background:
- Cleft lip (CL) and cleft palate (CP) are common congenital conditions requiring surgical intervention.
- Understanding the influence of race/ethnicity on surgical timing and outcomes is crucial for equitable care.
Purpose of the Study:
- To investigate the impact of race/ethnicity on the timing of primary cleft lip and cleft palate repair.
- To analyze postoperative outcomes, including readmission and reoperation rates, stratified by race and ethnicity.
Main Methods:
- Cross-sectional analysis of the National Surgical Quality Improvement Program Pediatric (NSQIP-P) database (2013-2018).
- Inclusion of patients under 2 years undergoing primary CL or CP repair.
- Outcomes assessed included surgical timing and 30-day readmission/reoperation rates, analyzed by race and ethnicity.
Main Results:
- Lower rates of CL repair over time were observed in Hispanic and Asian children compared to White infants.
- CP repair rates were significantly lower in Black, Hispanic, and Asian children versus White infants.
- Asian patients showed the highest rates of delayed repair, not meeting ACPA guidelines. Black and Hispanic children had higher odds of readmission after CL repair.
Conclusions:
- Significant racial/ethnic disparities exist in the timing and receipt of cleft repair.
- Asian patients are more likely to experience delayed surgical repair, and non-White children face poorer postoperative outcomes.
- Further research is needed to address these disparities in cleft care.
Objective:
To examine the impact of race/ethnicity on timing and postoperative outcomes of primary cleft lip (CL) and cleft palate (CP) repair.
Design:
Cross-sectional analysis of the National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2013 to 2018.
Patients And Main Outcome Measures:
Patients under 2 years of age who underwent primary CL or CP repair were identified in the NSQIP-P. Outcomes were the timing of surgery and 30-day readmission and reoperation rates stratified by race and ethnicity.
Results:
In total, 6021 children underwent CL and 6938 underwent CP repair. Adjusted rates of CL repair over time were 10% lower in Hispanic children (95%CI: 0.84-0.96) and 38% lower for Asian children (95%CI: 0.55-0.70) compared with White infants. CP repair rates over time were 13% lower in Black (95%CI: 0.79-0.95), 17% lower in Hispanic (95%CI: 0.77-0.89), and 53% lower in Asian children (95%CI: 0.43-0.53) than in White infants. Asian patients had the highest rates of delayed surgical repair, with 19.3% not meeting American Cleft Palate-Craniofacial Association (ACPA) guidelines for CL (P < .001) and 28.2% for CP repair (P< .001). Black and Hispanic children had 80% higher odds of readmission following primary CL repair (95%CI: 1.16-2.83 and 95%CI: 1.27-2.61, respectively).
Conclusions:
This study of a national database identified several racial/ethnic disparities in primary CL and CP, with reduced receipt of cleft repair over time for non-White children. Asian patients were significantly more likely to have delayed cleft repair per ACPA guidelines. These findings underscore the need to better understand disparities in cleft repair timing and postoperative outcomes.
