Socioeconomic Disparities in Secondary Speech Surgery Following Palatoplasty: A Global Network Study

The impact of low socioeconomic status (SES) on access to secondary speech procedures following cleft palate (CP) repair remains poorly understood. This study examined the association between SES-related diagnoses and the likelihood of undergoing secondary speech surgery among patients with CP and a history of hypernasality who had previously received primary palatoplasty. On April 8, 2025, the de-identified global network database TriNetX was queried for patients with CP using ICD-10 and CPT codes. Patients were categorized based on the presence or absence of lower SES-related ICD-10 codes. Outcomes included rates of secondary speech procedures such as palate revision, pharyngeal flap, and secondary palate lengthening. Propensity score matching was used to adjust for covariate differences. Out of 10,363 patients with CP and hypernasality who underwent palatoplasty between 2010 and 2024, 2,207 (21.3%) had an SES-related diagnosis. Patients identifying as African American/Black ( P <0.0001) and Hispanic/Latino ( P =0.0460) were significantly more likely to have SES-related diagnosis codes. Rates of secondary palate lengthening ( P <0.036) and palatoplasty with pharyngeal flap ( P <0.0001) were significantly lower among patients with lower SES-related diagnoses compared with those without. These findings highlight significant disparities in access to secondary speech surgery based on socioeconomic disadvantage. Patients with lower SES were less likely to receive procedures that may improve speech outcomes, underscoring the need for targeted efforts to promote surgical equity in cleft care.