The Impact of Socioeconomic Deprivation on Timing and Long-Term Outcomes of Cleft Surgery: A 30-Year Retrospective Analysis

Authors

• Valeria Mejia, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Raina K. Patel, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Artur Manasyan, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Asli Pekcan, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Melanie Bakovic, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Medha Vallurupari, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Erin Wolfe, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Alyssa Valenti, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Mark M. Urata, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• William P. Magee, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Jeffrey A. Hammoudeh, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.

Document Type

Journal Article

Publication Date

2-16-2026

Journal

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association

DOI

10.1177/10556656251361676

Keywords

cleft lip and palate; epidemiology; palatoplasty

Abstract

ObjectiveTo assess the impact of neighborhood socioeconomic deprivation on the timing of cleft surgery and outcomes, including postoperative palatal fistula and velopharyngeal insufficiency (VPI).DesignRetrospective cohort study.SettingSingle pediatric tertiary care center.Patients, ParticipantsA total of 702 patients who underwent cleft repair between 1995 and 2024, categorized by Area Deprivation Index (ADI) into low, medium, and high socioeconomic deprivation.InterventionsPrimary cleft lip (CL) and cleft palate (CP) repair, palatal fistula repair, and VPI surgery.Main Outcome Measure(s)Age at CL and CP repair, surgical delay (CL repair >6 months, CP repair >12 months), palatal fistula rate, time to fistula repair, and VPI surgery incidence.ResultsPatients in high-ADI areas experienced later CL (P < 0.05) and CP repairs (low ADI: 1.1 years; medium: 1.7 years; high: 1.8 years; P < 0.05). Logistic regression identified high ADI and female sex as independent predictors of CL delay (P < 0.001), while public insurance, race, greater hospital distance, and prior CL delay contributed to CP repair delays (P < 0.001). Palatal fistula rates (14.9%) were not linked to ADI, but high-ADI patients had longer times to repair (P < 0.05). Patients undergoing VPI surgery lived closer to the hospital than those not requiring repair (P < 0.05).ConclusionsHigher ADI and female sex were associated with CL repair delays, while CP repair delays correlated with public insurance, race, hospital distance, and prior CL delay. Targeted interventions are needed to improve timely cleft care.

APA Citation

Mejia, Valeria; Patel, Raina K.; Manasyan, Artur; Pekcan, Asli; Bakovic, Melanie; Vallurupari, Medha; Wolfe, Erin; Valenti, Alyssa; Urata, Mark M.; Magee, William P.; and Hammoudeh, Jeffrey A., "The Impact of Socioeconomic Deprivation on Timing and Long-Term Outcomes of Cleft Surgery: A 30-Year Retrospective Analysis" (2026). GW Authored Works. Paper 8708.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8708

Department

School of Medicine and Health Sciences Student Works