Reducing Racial, Ethnic, and Socioeconomic Disparities in Frenotomy Practice

Objective: Surgical correction of ankyloglossia through frenotomy has increased over 10-fold in the past decade, despite not seeing any significant improvement in breastfeeding rates. Due to heightened attention to this diagnosis and lack of consensus on treatment, we sought to evaluate our regional practice and standardize the screening for ankyloglossia. Materials and Methods: A retrospective cohort study of frenotomy practice within the birth hospital stay was conducted from June 1, 2019, to June 30, 2021. Patients were identified through billing data and grouped according to race, ethnicity, and health insurance status. The Tongue-tie and Breastfed Babies pictorial tool was then implemented regionally to test for differences. Post-intervention data was analyzed from June 1, 2023, to December 31, 2024. Chi-squared analysis was performed to test for differences. Results: Pre-intervention, there were significant disparities in frenotomy rates, with privately insured patients 2.75 times more likely than those with public insurance to receive a frenotomy during their birth hospitalization (OR 2.75, 95% CI: 2.43-3.12, p < 0.0001). Non-Hispanic White infants were 2.3 times more likely than non-Hispanic Black patients (OR 2.31, 95% CI: 1.94-2.74, p < 0.0001) and 3.9 times more likely than Hispanic infants to undergo the procedure (OR 3.87, 95% CI: 2.19-6.86, p < 0.0001). After the standardization, there were no longer any statistically significant disparities in frenotomy rates by insurance payor status as well as those between non-Hispanic White and non-Hispanic Black patients. Non-Hispanic White infants were still slightly more likely than Hispanic patients to undergo the procedure, but the odds ratio decreased significantly to just 1.37 (OR 1.37, 95% CI: 1.04-1.80, p = 0.0265). Conclusion: These findings suggest that standardizing the assessment of ankyloglossia can improve disparities among those who receive a frenotomy.