Optimal Timing of Cleft Lip Repair: Correlation With Scar Formation and Revision Rates

To evaluate whether earlier timing of cleft lip repair (CLR) is associated with differences in the incidence of hypertrophic scar (HTS) formation and the need for revision surgery.

Retrospective cohort study.

TriNetX Analytics Network, a federated database of de-identified health records from multiple healthcare institutions.

Infants who underwent primary CLR before 1 year of age were identified using ICD-10 and CPT codes. Patients were categorized into early cleft lip repair (ECLR, <3 months) and traditional cleft lip repair (TLR, 3-12 months) groups. Propensity score matching was performed. Rates of HTS and revision surgery were compared between groups using chi-squared tests and regression analyses.

Among 6786 patients, 4321 underwent ECLR and 2465 underwent TLR. HTS was significantly less common in the ECLR group (3.2%) than in the TLR group (5.2%, P = .002). Increasing age at repair was positively correlated with HTS incidence (r² = 0.58, P = .048). However, revision surgery was more frequent following ECLR (6.6%) compared to TLR (2.6%, P < .001) with age inversely correlated to revision rate (r² = 0.52, P = .104). These differences persisted after propensity score matching for demographic and clinical variables.

Earlier CLR (<3 months) is associated with a lower rate of hypertrophic scarring but a higher rate of revision surgery. These findings underscore a trade-off in timing decisions and may guide shared decision-making for surgical planning in patients with cleft lip.