The Impact of Socioeconomic Deprivation on Timing and Long-Term Outcomes of Cleft Surgery: A 30-Year Retrospective Analysis

Abstract

Objective

To assess the impact of neighborhood socioeconomic deprivation on the timing of cleft surgery and outcomes, including postoperative palatal fistula and velopharyngeal insufficiency (VPI).

Design

Retrospective cohort study.

Setting

Single pediatric tertiary care center.

Patients, Participants

A total of 702 patients who underwent cleft repair between 1995 and 2024, categorized by Area Deprivation Index (ADI) into low, medium, and high socioeconomic deprivation.

Interventions

Primary cleft lip (CL) and cleft palate (CP) repair, palatal fistula repair, and VPI surgery.

Main Outcome Measure(s)

Age at CL and CP repair, surgical delay (CL repair >6 months, CP repair >12 months), palatal fistula rate, time to fistula repair, and VPI surgery incidence.

Results

Patients in high-ADI areas experienced later CL (P < 0.05) and CP repairs (low ADI: 1.1 years; medium: 1.7 years; high: 1.8 years; P < 0.05). Logistic regression identified high ADI and female sex as independent predictors of CL delay (P < 0.001), while public insurance, race, greater hospital distance, and prior CL delay contributed to CP repair delays (P < 0.001). Palatal fistula rates (14.9%) were not linked to ADI, but high-ADI patients had longer times to repair (P < 0.05). Patients undergoing VPI surgery lived closer to the hospital than those not requiring repair (P < 0.05).

Conclusions

Higher ADI and female sex were associated with CL repair delays, while CP repair delays correlated with public insurance, race, hospital distance, and prior CL delay. Targeted interventions are needed to improve timely cleft care.