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Racial Disparities in Cleft Palate Repair

Wu, Robin T. M.D.; Peck, Connor J. B.S.; Shultz, Blake N. B.S.; Travieso, Roberto M.D.; Steinbacher, Derek M. M.D., D.M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1738-1745
doi: 10.1097/PRS.0000000000005650
Pediatric/Craniofacial: Original Articles
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Background: Various factors can influence outcomes in cleft palate care. This study sought to determine the impact of race on admissions, hospital costs, and short-term complications in cleft palate repair.

Methods: Cleft palate operations were identified in the Kids’ Inpatient Database data, from 2000 to 2009. Data were combed for demographics, perioperatives, complications, and hospital characteristics. Bivariate and multivariate analyses were performed between races in total, primary, and revision cohorts.

Results: There were 3464 white, 1428 Hispanic, 413 black, 398 Asian/Pacific-Islander, and 470 patients of other races captured. Black patients experienced more emergent admissions (p = 0.005) and increased length of stay (p = 0.029). Hospital charges were highest for black and Hispanic patients and lowest for white patients (p = 0.019). Black patients had more total complications than non-black patients (p = 0.039), including higher rates of postoperative fistula (p = 0.020) and nonspecific complications among revision repairs (p = 0.003). Asian/Pacific Islander in the primary cohort experienced higher rates of accidental puncture (p = 0.031) and fistula (p < 0.001). Other patients had the highest rates of wound disruption (p = 0.013). After controlling for race, diagnosis, Charlson Comorbidity Index score, region, elective/nonelective, payer, and income quartile, length of stay (p < 0.001) and age (p < 0.001) were associated with increases in both total complications and costs.

Conclusions: Race may play a significant role in cleft palate repair, as white patients had fewer complications, shorter length of stay, and lower costs following repair. Delayed age at treatment may predispose patients to adverse sequelae in minority populations, in terms of influencing length of stay and costs.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

New Haven, Conn.

From the Department of Surgery, Section of Plastic Surgery, Yale School of Medicine.

Received for publication June 5, 2018; accepted October 31, 2018.

The first two authors contributed equally to this work as co-first authors.

Presented at the 59th Annual Meeting of the New England Society of Plastic and Reconstructive Surgery, in Manchester Village, Vermont, June 8 through 10, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Derek M. Steinbacher, M.D., D.M.D., Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine, P.O. Box 8041, New Haven, Conn. 06520-8062, derek.steinbacher@yale.edu, Instagram: @dereksteinbacher

Copyright © 2019 by the American Society of Plastic Surgeons