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Updated: May 5, 2026
Surgical Management of Meatal Stenosis with Meatoplasty
Published on: November 30, 2010
Disparities in Surgical Intervention in Pediatric Patients With Submucous Cleft Palate and Velopharyngeal Dysfunction
Soukaina Eljamri1, Pooja D Reddy1, Amber Shaffer2
1Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Insights
Patients from less disadvantaged neighborhoods received earlier surgery for submucous cleft palate (SMCP) and velopharyngeal dysfunction (VPD). Social determinants of health are crucial for timely SMCP and VPD treatment.
Area of Science:
- Craniofacial Surgery
- Pediatric Otolaryngology
- Health Services Research
Background:
- Submucous cleft palate (SMCP) and velopharyngeal dysfunction (VPD) often require surgical intervention.
- Factors influencing surgical access and timing are critical for optimal patient outcomes.
- Social determinants of health may play a role in healthcare disparities.
Purpose of the Study:
- To identify factors affecting the timing and access to surgery for patients with SMCP and VPD.
- To investigate the impact of socioeconomic status, geographic distance, and insurance on surgical treatment.
- To inform strategies for equitable care in managing SMCP and VPD.
Main Methods:
- Retrospective cohort study of 168 patients with SMCP and VPD (2004-2021).
- Analysis of Area Deprivation Index (ADI), Child Opportunity Index (COI), distance to care, and insurance status.
- Statistical analysis including regression models to assess associations with surgical status and timing.
Main Results:
- No significant differences in ADI, COI, insurance, or distance between surgical and non-surgical groups.
- Surgical patients had more overt SMCP, earlier diagnosis, and higher baseline speech scores.
- Younger age at surgery correlated with higher speech scores and lower state ADI deciles.
Conclusions:
- Patients from less deprived areas underwent surgery earlier.
- Social determinants of health, particularly neighborhood disadvantage, are associated with surgical timing for SMCP/VPD.
- Integrating social determinants into care evaluations can prevent treatment delays.
Objective:
To evaluate factors impacting access to and timing of surgery in patients with submucous cleft palate (SMCP) and velopharyngeal dysfunction (VPD).
Study Design:
Retrospective cohort study.
Setting:
Single academic medical center.
Methods:
Patients with SMCP and VPD between 2004 and 2021 were identified. Variables included national and state area deprivation index (ADI) percentiles, child opportunity index (COI) categories, distance to care, and insurance status. χ2, Fisher's exact test, Wilcoxon rank-sum, Spearman rank correlation, t test, and linear regression (α = .05) were used to investigate the relationships between these variables and surgical status and timing.
Results:
A total of 168 patients were included, 94 surgical and 74 nonsurgical. Patients were predominantly white (160/168; 95.2%), Male (103/168; 61.3%), and non-Hispanic (153/168; 91.1%). There were no intergroup differences with respect to ADI, COI, insurance status, or distance from the hospital. Surgical patients were more likely to have overt SMCP (P = .03), earlier age at SMCP diagnosis (P = .02), and higher baseline Pittsburgh weighted speech score (PWSS) (P = <.001). In multivariable regression, younger age at surgery was found to be significantly associated with higher baseline PWSS (P = .001) and lower state ADI deciles (P = .03). Patients with private insurance had a lower baseline PWSS than those with public insurance (P = .04). Insurance status was not significantly associated with age at diagnosis (P = .79) or age at surgery (P = .08).
Conclusion:
In this study, patients from less disadvantaged neighborhoods were found to have earlier surgical intervention, highlighting the importance of incorporating social determinants of health in the evaluation of VPD and SMCP patients to prevent treatment delays.
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