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- Title
Race-Based Differences in the Utilization and Timing of Secondary Cleft Procedures in the United States.
- Authors
Peck, Connor J.; Pourtaheri, Navid; Parsaei, Yassmin; Gowda, Arvind U.; Yang, Jenny; Lopez, Joseph; Steinbacher, Derek M.
- Abstract
Objective : Secondary procedures optimize outcomes following cleft lip and palate (CL/P) repair. We analyzed the association between race and the utilization and timing of revisionary/secondary cleft surgeries in the United States. Design : Primary CL/P repair, revisions, and secondary procedures—cleft rhinoplasty, speech surgery, and alveolar bone grafting (ABG)—performed from 2014–2018 were identified from the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Utilization estimates were derived via univariable and multivariable logistic regression. A Kruskal-Wallis rank-sum test and multivariable linear regression were used to assess differences in timing for each procedure cohort. Main Outcome Measures : The primary outcome measures were the odds of a patient being a certain race/ethnicity, and the age at which patients of different race/ethnicity receive surgery. Results : There were 23 780 procedures analyzed. After controlling for sex, diagnosis, and functional status, there were significant differences in utilization estimates across procedure groups. Primarily, utilization was lowest in patient who were Black for cleft rhinoplasty (OR = 0.70, P =.023), ABG (OR = 0.44, P <.001) and speech surgery (OR = 0.57, P =.012), and highest in patients who were Asian patients in all surgery cohorts (OR 2.05-4.43). Timing of surgery also varied by race, although differences were minimal. Conclusions: Estimates of utilization and timing of secondary cleft procedures varied by race, particularly among patients who were Black (poor utilization) or Asian (high utilization). Further studies should identify the causes and implications of underutilized and/or delayed cleft care.
- Subjects
UNITED States; RHINOPLASTY; KRUSKAL-Wallis Test; RACISM; MULTIVARIATE analysis; MULTIPLE regression analysis; RACE; CLEFT palate; HEALTH outcome assessment; ALVEOLAR process; CLEFT lip; HEALTH equity; ODDS ratio; LONGITUDINAL method; BONE grafting; EVALUATION
- Publication
Cleft Palate Craniofacial Journal, 2022, Vol 59, Issue 11, p1413
- ISSN
1055-6656
- Publication type
Article
- DOI
10.1177/10556656211047134