Cleft Palate Repair in a Socially Vulnerable Area: Analysis of Sociodemographic Differences on Surgical Timing

Timely cleft palate repair is essential for optimal speech development and reducing long-term morbidity. Children from socially vulnerable or underserved populations often experience delays in surgical care. This study examines the impact of race, insurance, and social vulnerability index (SVI) on the timing of primary cleft palate repair in a state with significant health care disparities.

A retrospective review was conducted for 147 patients who underwent primary palatoplasty between 2011 and 2021 at the state's only ACPA-approved center. Demographic variables, cleft characteristics, surgical details, and timing of repair were collected. Categorical variables were compared using the χ2 or Fisher-Freeman-Halton test. Nonparametric tests and linear regression models were used for continuous variables.

Standard-timing repair was most common (42.2%), followed by early (36.1%) and late repairs (21.8%). Race and SVI were not associated with surgical timing. Insurance status was associated with the distribution of repair timing (P=0.04), with government-insured children more frequently undergoing repair in the standard window; however, their proportion of late repairs was not higher than that of private-insured children. Procedure type also differed by timing (P<0.001). Multivariable analyses found no independent associations between race, insurance status, SVI, or Veau classification and either age at repair or late repair.

Insurance status and operative technique were associated with the unadjusted distribution of repair timing; however, race, insurance status, SVI, and Veau classification were not independently associated with age at repair or late repair. Centralized cleft team care may have contributed to the absence of observed differences by race and SVI.