Impact of Demographics and Comorbidities on Timing of Primary Cleft Lip Repair: Trends Over 10 Years

Objective Optimal timing for primary cleft lip (CL) repair remains controversial due to a paucity of literature reporting outcomes. This study sought to identify trends in timing of CL repair over a 10-year period. Design and Setting Cross-sectional analysis of the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) between 2013 and 2022. Patients, Participants, Interventions CL patients undergoing primary CL repair were divided into 4 cohorts based on age (months) at repair: 0 to 3, 3 to 6, 6 to 9, and 9 to 12. Main Outcome Measure Univariable statistics, multivariable regressions, and trend analyses were conducted to identify predictors for operation at latter ages and to evaluate trends over time. Results 11,585 CL patients were identified with the majority undergoing repair between 3 and 6 months of age (63%). White and Asian patients predominately underwent repair between 0 and 3 months (68% and 5%, respectively), while African American and Hispanic patients underwent repair between 9 and 12 months (12% and 22%, respectively, P < .001). On regression analysis, patients with cardiac risk factors (CRF), asthma, bronchopulmonary dysplasia, developmental delay, CNS abnormalities, and nutritional supplementation ( P < .001) were more likely to be repaired at later time intervals. Over the past decade, Hispanic and Asian patients undergoing CL repair increased between 0 and 3 (β = 0.06) and 3 and 6 (β = 0.05) months of age, respectively. Patients with CRF and airway abnormalities also significantly increased between 0 and 3 months. Conclusion The present study identified an increase in non-White patients and patients with severe comorbidities undergoing early CL repair over a 10-year period. Healthcare professionals should note these trends when treating their own patient populations.