The Association of Neighborhood Disadvantage with Surgical Outcomes and Follow-up Adherence in Patients with Cleft Palate

Abstract

Objective

To assess the relationship between neighborhood-level social disadvantage, as measured by Area Deprivation Index (ADI) and Childhood Opportunity Index (COI), and postoperative outcomes and follow-up care after primary or secondary cleft palate repair.

Design

Retrospective cohort study.

Setting

Academic tertiary care center.

Patients

Pediatric patients with cleft palate with or without cleft lip (CP ± L).

Interventions

Primary palatoplasty, revision palatoplasty, or closure of oronasal fistula.

Main outcome measures

Postoperative complications and clinic follow-up adherence.

Results

A total of 244 patients were included in the study. Among all patients, there was only a moderate correlation between patients’ ADI and COI quintiles (R² = 0.465, P < .001). In patients undergoing primary palatoplasty, greater ADI neighborhood deprivation was significantly associated with a greater number of no-show (P = .011) and cancelled (P = .025) clinic appointments. In patients undergoing revision palatoplasty, greater ADI neighborhood deprivation was significantly associated with higher rates of postoperative complications (P = .016) and a greater number of no-show clinic appointments (P = .036). Greater COI disadvantage was associated with significantly higher rates of hospital readmission (P = .049) and fewer cancelled clinic appointments (P = .049) in revision palatoplasties. Neighborhood disadvantage was not predictive of any oronasal fistula repair postoperative outcomes, follow-up adherence, or patient characteristics at surgery.

Conclusions

Neighborhood-level social disadvantage indices are predictive of suboptimal surgical outcomes and follow-up adherence in patients undergoing cleft palate surgery and could be used to identify patients who may benefit from additional clinic outreach and support.