Differing Outcomes of Cleft Lip and Palate Repair Based on Patient Race, Ethnic Background, and Preferred Spoken Language
Abstract
Introduction
Orofacial clefts are a common congenital craniofacial malformation that occur when the facial prominences fail to fuse during the early weeks of development. Cleft palate and lip repair outcomes vary substantially in terms of feeding ability, speech ability, social skills, and aesthetics. Prior studies have noted increased lag time in the preoperative period in minority, non-English speaking populations as well as disordered speech outcomes for adopted children that undergo late palatoplasty. Thus, language and/or racial barriers could potentially contribute to these variable outcomes. Thus, this study aims to analyze differing outcomes of cleft lip and palate repair.
Methods
A retrospective review of cleft lip and palate patient care notes written prior to 4/23/2021 was completed. Variable repair outcomes were analyzed based on speech therapy attendance and compliance rate, feeding difficulties, behavioral difficulties, and educational difficulties. T-tests, ANOVA analyses, and logistic regression analyses were used to examine repair outcomes based on differential demographic features (race, ethnic background, and spoken language of patients) compared to a white, English-speaking control population.
Results
337 patients that underwent cleft lip or palate repair met inclusion criteria. 53% attended speech therapy, signifying some form of speech delay. The only demographic feature found to be significantly associated with speech therapy attendance was race (p < 0.001). Specifically, Asians were 7.191 times more likely (95% CI 3.084, 16.767, p < 0.001) to attend speech therapy compared to the control group. Additionally, 10% exhibited behavioral delays, 6% exhibited educational delays, and 9% of patients experienced feeding difficulties. No statistically significant associations were found between these outcomes and race, ethnic background, or spoken language. 90 patients received speech therapy directly through CHKD. Asian patients had the highest mean compliance rate of 97.49% (95% CI 95.47, 99.52, p < 0.05), and Black/African American patients had lowest mean compliance rate of 81.51% (95% CI 70.38, 92.63, p < 0.05). Ethnic background (p = 0.1455) and spoken language of patients (p = 0.5496) was not associated with speech therapy compliance rate.
Conclusion/Discussion
Tangible discrepancies in cleft lip and palate repair outcomes exist regarding different patient demographics.