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Characterizing Comprehensive Cleft Care in the United States: A National Inpatient Sample Study
Nicholas Paliwoda1, Ethan D Paliwoda1, Avi A Gajjar2
1Division of Plastic Surgery, Department of Surgery, Albany Medical Center.
Insights
Cleft lip and palate (CLP) care costs vary significantly, with disparities impacting outcomes for Native American patients and those with higher mortality risks. Addressing these systemic barriers is crucial for equitable treatment.
Area of Science:
- Craniofacial Anomalies
- Health Services Research
- Health Economics
Background:
- Cleft lip and palate (CLP) are common congenital craniofacial anomalies affecting critical functions like feeding and speech.
- Effective management of CLP requires a multidisciplinary approach, encompassing surgery, orthodontics, speech therapy, and psychosocial support.
- Understanding the factors influencing healthcare costs and patient outcomes is vital for optimizing CLP care.
Purpose of the Study:
- To examine demographic, clinical, and economic factors associated with hospital charges and outcomes in cleft lip and palate management.
- To identify predictors of non-home discharge and extended length of stay (LOS) in patients treated for CLP.
- To highlight potential sociodemographic and geographic disparities in CLP care within the United States.
Main Methods:
- Utilized ICD-10-CM/PCS codes and data from the National Inpatient Sample (NIS) for 2016-2017.
- Included patients primarily or secondarily treated for combined cleft lip and palate.
- Employed descriptive statistics for baseline analysis and multivariable logistic regression to identify factors influencing non-home discharge and extended LOS.
Main Results:
- The study analyzed 4205 patients, with a mean cost of care of $13,291 and average hospital charges of $49,229.
- Native American patients and those with higher mortality risks had increased odds of non-home discharge.
- Patients of unspecified racial background, treated at urban non-teaching hospitals, or with higher mortality risks showed higher odds of extended LOS.
Conclusions:
- Significant sociodemographic and geographic disparities exist in cleft lip and palate care.
- Factors such as race, hospital type, and mortality risk influence discharge disposition and length of hospital stay.
- Standardizing care protocols and addressing systemic barriers are essential for improving CLP patient outcomes and reducing financial burdens.
Abstract:
Cleft lip and palate (CLP) are among the most common congenital craniofacial anomalies impacting feeding, speech, and facial appearance. Comprehensive management involves multidisciplinary care, including surgical interventions, orthodontics, speech therapy, and psychosocial support. This study examines demographic, clinical, and economic factors influencing hospital charges and outcomes associated with CLP management in the United States. Using ICD-10-CM/PCS codes and data from the National Inpatient Sample (NIS) for 2016 and 2017, this study included patients primarily or secondarily treated for combined CLP. Baseline demographics and outcomes were analyzed using descriptive statistics, and multivariable logistic regression was used to identify factors influencing non-home discharges and extended length of stay (LOS). The study population comprised 4205 patients (60.2% male and 39.8% female). The majority were White (44.3%) and Hispanic (29.3%). Most patients were privately insured (47.0%) or on Medicaid (42.7%). The mean cost of care was $13,291, and total hospital charges averaged $49,229, inflation adjusted. The average LOS was 1.981 days (SD=6.850), and 1.3% of patients experienced non-home discharges. Native American patients and those with higher risks of mortality showed higher odds of non-home discharge, whereas patients in the West had lower odds of non-home discharge. Those of unspecified racial background, treated at urban non-teaching hospitals, or with higher risks of mortality experienced higher odds of extended LOS. This study highlights sociodemographic and geographic disparities in CLP care. Addressing systemic barriers and standardizing care protocols are essential to improving outcomes and reducing financial burdens.
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