Early Cleft Lip Repair: Who's Getting it and Why Sociodemographics Matter

Abstract

Objective

To analyze the sociodemographic factors influencing access to early cleft lip repair (ECLR) at our institution, with the goal of identifying and addressing disparities in care.

Design

Retrospective cohort study.

Setting

Single-center, tertiary hospital.

Patients/Participants

Patients who underwent ECLR at a pediatric hospital in Los Angeles between 2014 and 2024 were included. Sociodemographics included median household income, parental unemployment rates, insurance, race/ethnicity, and area deprivation index (ADI).

Intervention

ECLR, performed before 3 months of age.

Main Outcome Measures

Age at surgery, perioperative complications, and readmission/revision rates.

Results

A total of 271 patients met inclusion criteria. The mean age at ECLR was 35 ± 19 days, with 94.8% residing in-state. Racial and ethnic disparities were observed in the timing of surgery, with White patients undergoing ECLR at a younger age than non-White patients (P = 0.01). Publicly insured patients had later surgeries and higher complication rates compared to privately insured patients (P = 0.005 for both). A higher ADI was associated with older age at surgery (r = 0.15, P = 0.02), while patients from lower ADI areas had significantly lower readmission rates (P = 0.04). Income and parental unemployment did not significantly affect outcomes.

Conclusions

Access to ECLR was influenced by sociodemographic factors, with public insurance linked to delayed surgery and higher complication rates. While ADI did not significantly impact outcomes, it highlighted geographic disparities. To promote more equitable care, cleft surgeons should consider refining eligibility criteria and providing additional support, particularly for non-White and publicly insured patients.