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Delay in Cleft Lip and Palate Surgical Repair

An Institutional Review on Cleft Health Disparities in an Urban Population

Zaluzec, Rebekah M. DO*; Rodby, Katherine A. MD*; Bradford, Perry S. MD; Danielson, Kirstie K. PhD; Patel, Pravin K. MD*; Rosenberg, Janine PhD

doi: 10.1097/SCS.0000000000005740
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Access to specialized medical care is critical to decrease complications and minimize long-term morbidity, yet racial disparities in cleft surgery persist as time to initial reconstruction remains delayed among minority patients. Research has demonstrated an average 3-week delay in surgery for minority patients nationally. A retrospective chart review of patient demographics, visit timing, and surgical history was performed for patients who underwent primary cleft lip with or without palate (CL + P) reconstruction between 2002 and 2016 at an urban craniofacial center. Of the 89 children who underwent surgery, 87% were ethnic minorities (58% Hispanic, 25% African-American, 4% Asian/Other). Caucasian children were the earliest to receive CL (3.5 months) and CP (13-months) repair. Minority children trended toward a delay in CL repair, with surgery for African-Americans at 5-months (P = 0.06) and Hispanics at 4.8-months (P = 0.07). Time from first visit to CL surgery showed significant delays for minority, non-English speaking, and public insurance patients; however, for CP repair, male children were delayed from first visit to surgery compared to females (P = 0.03). While there was no statistical difference in age at CL or CP surgical repair among our racial/ethnic cohorts, there were significant racial/ethnic differences in timing spent in the preoperative period for CL. However, racial/ethnic differences decreased as the patients spent more time within the healthcare system. Thus, established, interdisciplinary cleft/craniofacial centers well versed in minority patients can minimize the complex social and cultural factors that contribute to delays in cleft care.

*Division of Plastic, Reconstructive and Cosmetic Surgery

University of Illinois Health Craniofacial Center

Division of Transplant Surgery, University of Illinois Hospital and Health Science System, Chicago, IL.

Address correspondence and reprint requests to Janine Rosenberg, PhD, Craniofacial Center, University of Illinois Hospital and Health Science System, 811 S Paulina St (MC 588), Chicago, IL 60612; E-mail: jmrosen@uic.edu

Received 1 January, 2019

Accepted 8 May, 2019

The authors report no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com).

© 2019 by Mutaz B. Habal, MD.