Don't Delay: Sociodemographic Factors Impacting Timing of Cleft Lip Repair

Optimal treatment of cleft lip (CL) with or without cleft palate requires early evaluation, surgical planning, and timely repair. Sociodemographic barriers may cause delays in the treatment of patients with CL. This study aims to identify the sociodemographic and clinical factors that may delay CL repair. This IRB-approved retrospective analyzed patients treated for CL at a tertiary academic center (2015-2023). The primary outcome was age at CL surgery, with >6 months considered delayed. Surgical timing was compared across sociodemographic factors. A total of 241 patients (88 White, 72 Hispanic, 21 Black, and 60 other) were included. Of these, 84 had isolated CL and 157 had cleft lip and palate. The median repair age was 4.5 months (IQR: 3.8-5.7), with 79.3% undergoing surgery by 6 months. Delays in CL repair were more common in families with <$75,000 income (25.0% versus 14.0%; P =0.04), Medicaid insurance versus private (25.4% versus 9.7%; P <0.01), Black (18.2%) or Hispanic (27.8%) versus White patients (11.7%; P =0.049), and those with medical comorbidities (54.0% versus 15.3%, P <0.001). Nasoalveolar molding (NAM) reduced delay, whereas cleft lip adhesion (CLA) surgery increased it (10.1%, 82.4%, and 18.7% for NAM, CLA, no infant orthopedic, respectively; P <0.001). Multivariate analysis identified medical comorbidities (OR: 8.21; P <0.001) and CLA (OR 46.4, P <0.001) as strong predictors of delay, whereas NAM use predicted timely repair (OR: 0.19, P <0.01). Sociodemographic factors were not independent predictors. Institutional and state-level programs targeting these factors may help decrease the barriers to CL care.