Cleft Palate Revision Surgery: A Report on Sociodemographic and Racial Influences

Boydstun, A. G., Edwards, S. R., Elver, A. A., Humphries, L. S., & Hoppe, I. C. (2025). Cleft Palate Revision Surgery: A report on Sociodemographic and Racial Influences. Journal of Craniofacial Surgery. https://doi.org/10.1097/scs.0000000000011505

Research paper

Background

After an initial cleft palate repair, some patients require additional surgeries to improve function and appearance. This analysis of over 9,000 patients from 2013-2023 reveals that sociodemographic factors, especially race and social vulnerability, significantly influence who receives these crucial follow-up procedures after their first cleft palate surgery.

Methods: What Researchers Did

The researchers looked back at a huge database (Epic Cosmos) with information from over 200 million patients from more than 1,000 hospitals and over 32,000 clinics. They studied patients with cleft palate who had their first surgery between 2013 and 2023. They sorted the patients into groups based on their race, where they lived (city or country), and a "Social Vulnerability Index," which is a rating that shows how at-risk a community is based on things like money, family life, and language spoken.

Results: What Researchers Found

The study found that patients who were socially vulnerable and Black patients had the lowest rates of getting follow-up surgeries. Asian and Pacific Islander patients had the highest rates. The researchers also noticed that socially vulnerable patients from minority groups and those who speak a different language also had a lower chance of getting follow-up surgeries.

The "Overall Picture"

Impact by Minority Status and Language

The study found that speech surgery rates were lowest among the most vulnerable patients in the minority and language group, at 9.3%, compared to 12.5% for patients in the next-least vulnerable quartile. This suggests that patients who are part of a minority group or who speak a language other than English may face additional barriers to getting the specialized care they need.

Impact by Housing Type & Transportation

Speech surgery rates were lowest in the highest quartile of vulnerability at 9.6%, which increased to 11.2% in the least vulnerable quartile. This indicates that having unstable housing or limited transportation can impact a patient's ability to get consistent follow-up care.

Impact by Race

Asian or Pacific Islander patients had the highest rates for both major revisions (7.2%) and speech surgery (12.3%). This is in contrast to Black patients, who had the lowest rates for major revisions (4.2%) and speech surgery (8.0%). White patients had a 3.8% rate for major revisions and a 10.6% rate for speech surgery. These findings suggest that a patient's race can be a factor in their access to and use of secondary surgical procedures.

Why It Matters/Next Steps