Children of nonwhite racial/ethnic backgrounds face significant disparities in access to and outcomes of cleft repair surgery, reports a study in the November issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The magazine is published in the Lippincott portfolio by Wolters Kluwer.
Our data show that nonwhite children with cleft lip are significantly more likely to experience delays, complications, and prolonged hospital stays than white children. Importantly, our analyzes also provide key insights into why such disparities might exist in a historically safe and common process.”
Derek Steinbacher, DMD, MD, ASPS Fellow Surgeon of West River Surgery Center in Guilford, Conn.
Nationwide study finds discrepancies in cleft lip surgery…
Cleft lip and/or palate repair surgery is performed to restore form and function in children with these common congenital malformations. In a previous study, the team of Dr. Steinbacher reported differences in cleft palate care. The new study builds on these findings by evaluating the outcomes of cleft lip repair surgery in US children of diverse racial/ethnic backgrounds.
The analysis included 5,927 children who underwent reconstructive surgery for cleft lip (without cleft palate repair) between 2006 and 2012. Data were drawn from the National Children’s Inpatient Database. Approximately 63% of patients were White, 22% Hispanic, five percent Black, five percent Asian/Pacific Islander, and six percent “other” race/ethnicity. Timing and outcomes of cleft lip repair surgery were compared between groups.
Data analyzes showed that non-white children were more likely to have delayed cleft lip surgery (after six months of age) – between 23% and 29%, compared to just 8% for white children. Non-white children were also nearly twice as likely to experience complications after surgery and more often had prolonged hospitalizations, although rates of both complications and prolonged hospital stays were low.
…But most differences are not specifically related to race/ethnicity
The researchers used various stepwise regression statistical models to adjust for the potential confounding effect of several other medical and sociodemographic factors. While some race/ethnicity differences remained even after adjusting for these factors—such as delays in surgery among Hispanic and Asian children—most appeared to be more closely related to other factors.
For example, having more underlying medical comorbidities was associated with significant delays in care, increased postoperative complications, prolonged hospital stay, and increased costs. Other contributing factors included the patient’s income status and location in the United States.
Similar to the previous study of cleft palate, the results show that nonwhite children with cleft lip are more likely to have delays in care, complications, and prolonged hospitalization, compared to white children. However, “differences in baseline health status may account for much of this disparity in combination with factors such as income, insurance type, and location,” the researchers write.
“Taken together, these data suggest a significant but complex relationship between patient race/ethnicity and outcomes in cleft lip repair,” Dr. Steinbacher and colleagues conclude. “The findings underscore the critical role of surgeons as advocates for policies and structures that increase equity in all aspects of pediatric care.”
Source:
Journal Reference:
Peck, CJ, Yassmin Parsaei, Jazayeri, HE, Desai, MM, Lopez, J., Uribe, FA, & Steinbacher, D. (2023). A national assessment of racial and ethnic disparities in cleft lip repair. Plastic & Reconstructive Surgery. doi.org/10.1097/prs.00000000000011203.
