Impact of Demographics and Comorbidities on Timing of Primary Cleft Lip Repair: Trends Over 10 Years

Area of Science:

• Pediatric Surgery
• Craniofacial Surgery
• Health Services Research

Background:

• Optimal timing for primary cleft lip (CL) repair is debated due to limited outcome data.
• Understanding trends in CL repair timing is crucial for surgical planning and resource allocation.

Purpose of the Study:

• To analyze trends in the timing of primary cleft lip repair over a 10-year period.
• To identify demographic and clinical factors associated with delayed CL repair.

Main Methods:

• A cross-sectional analysis of the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database from 2013-2022.
• 11,585 patients undergoing primary CL repair were categorized into four age cohorts at repair: 0-3, 3-6, 6-9, and 9-12 months.
• Statistical analyses included univariable statistics, multivariable regressions, and trend analyses.

Main Results:

• The majority of CL repairs (63%) occurred between 3 and 6 months of age.
• Significant racial/ethnic disparities in repair timing were observed, with White and Asian patients more likely to have early repair (0-3 months) and African American and Hispanic patients more likely to have later repair (9-12 months).
• Patients with cardiac risk factors, asthma, bronchopulmonary dysplasia, developmental delay, CNS abnormalities, and nutritional supplementation were more likely to undergo repair at later ages.
• Over the decade, there was an increase in early CL repair (0-3 months) among Hispanic patients and between 3-6 months for Asian patients.
• An increase in early repair (0-3 months) was also noted for patients with cardiac risk factors and airway abnormalities.

Conclusions:

• The study reveals a trend towards earlier cleft lip repair in non-White patients and those with significant comorbidities over the past decade.
• These demographic and clinical shifts necessitate awareness among healthcare professionals for tailored patient management.
• Further research should explore the implications of these timing trends on surgical outcomes and long-term patient well-being.