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The Role of Surgical Timing and Distance Traveled for Care for Patients Born With Cleft Palate
Victoria Fonseca1, Elena Quinonez1, Philip McDaniel1
1The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Insights
Longer travel distances delay crucial palate surgery, impacting patient outcomes. Addressing geographic barriers is essential for timely treatment and better results in craniofacial care.
Area of Science:
- Craniofacial Surgery
- Pediatric Health Outcomes
- Health Services Research
Background:
- Timely palate surgery is critical for optimal speech and facial development in children with cleft palate.
- Geographic barriers and travel distance can influence access to specialized craniofacial care.
- Understanding the impact of distance and surgical timing is essential for improving patient management.
Purpose of the Study:
- To evaluate the association between travel distance, surgical timing, and patient outcomes after palate surgery.
- To identify factors contributing to delayed surgical intervention.
- To inform strategies for mitigating geographic disparities in craniofacial care.
Main Methods:
- Retrospective cohort study of 198 patients undergoing palate surgery from 2016-2023.
- Analysis of electronic medical records to assess travel distance, age at surgery, and post-operative outcomes.
- Univariate and Kruskal-Wallis tests used to determine statistical significance.
Main Results:
- Increased travel distance correlated with later presentation and surgery (P=.042, P=.041).
- Earlier palate surgery was linked to fewer emergency department visits (P=.0159) and speech therapy referrals (P=.0255).
- Velopharyngeal insufficiency (VPI) incidence was 11.4% with no significant association with timing or distance.
Conclusions:
- Greater travel distance is a significant factor in delayed primary palate surgery.
- Addressing geographic disparities is vital for ensuring timely surgical intervention and improving outcomes.
- Optimizing access to care can reduce healthcare utilization and enhance developmental trajectories for children with cleft palate.
Abstract:
ObjectiveThis study evaluates the impact of travel distance and surgical timing on outcomes in patients undergoing palate surgery.DesignA retrospective cohort study analyzing patient data from electronic medical records. Univariate and Kruskal-Wallis analyses assessed associations between distance, timing, and outcomes.SettingA single academic, American Cleft Palate Craniofacial Association -approved tertiary craniofacial center in North Carolina.Patients, ParticipantsOne hundred and ninety-eight patients who underwent palate surgery from 2016 to 2023. Exclusion criteria included age >12 years, submucosal clefts, out-of-state residence, and lack of follow up.InterventionsPalate surgery categorized as early (<11 months), standard (11-13 months), or late (>13 months).Main Outcome Measure(s)Age at first craniofacial visit, age at surgery, time between visit and surgery, emergency department (ED) visits within 30 days of surgery, and incidence of velopharyngeal insufficiency (VPI) or speech therapy referral by age 3.ResultsMedian age at palate surgery was 10.1 months. Increased distance was significantly associated with increased age at clinic presentation (P = .042) and surgery (P = .041), but not increased time between first visit and surgery (P = .811). Earlier surgery was associated with reduced ED visits (P = .0159) and speech therapy referrals (P = .0255). VPI incidence was 11.4%, with no significant correlation to timing or distance.ConclusionsIncreased travel distance is associated with later primary palate surgery. Addressing geographic disparities is crucial to improving patient outcomes.
