P44. Cleft Palate Repair Timing Impacts Incidence of VelopharyngealIn Sufficiency

PURPOSE: This study builds upon recent findings from a 2023 multi-institutional trial, revealing that cleft palate (CP) repair at 12-months results in a significantly higher future need for velopharyngeal insufficiency (VPI) surgery than repair at six months. Using a 20-year dataset of California CP cases, we assess this with causal inference. METHODS: We extracted all California CP repairs from 2000-2021 and linked them to post-CP repair VPI surgeries. We employed propensity score matching (PSM) to model the primary outcome: VPI surgery incidence. Early CP repair was defined as <7 months, while traditional repair was >11 months. Key variables, including sex, race, payer, and distance to the hospital, were balanced using standardized mean differences (SMD). Non-syndromic cases were included. RESULTS: We analyzed 52,007 CP repairs, with 12,169 (23.3%) early repairs and 39,838 (76.7%) late repairs. Early CP repairs had a 1.2% (13/1000) VPI rate, while late repairs had 5.7% (61/1000. The PSM model demonstrated an average treatment effect of 5.9% reduction in VPI (p<.001, 95% CI -6.3- -5.4%). SMD balancing yielded these results: sex (before SMD = -.15, after SMD = -.01); distance to hospital (before SMD:.02, after SMD: -.01); race (before SMD= -.04, after SMD: -.01); payer (before SMD: -.11, after SMD:.01). CONCLUSION: Our 20-year dataset supports recent research, affirming that early CP repairs significantly reduce the need for VPI surgery. These findings underscore early CP repair's value as an independent preventive measure for VPI, potentially reducing surgical interventions and enhancing patient outcomes in this cohort.