Disparities in Appointment Attendance Among Children with Cleft Lip and Palate: A 10-Year Analysis

ObjectiveTo identify sociodemographic and clinical factors associated with missed outpatient plastic surgery appointments among children with cleft lip and palate (CLP).DesignRetrospective chart review.SettingSingle urban academic tertiary pediatric hospital.Patients/ParticipantsChildren with CLP who underwent cleft lip repair between 2015 and 2025. Exclusion criteria included <5 total outpatient visits during the study period or out-of-state primary residence.InterventionsNot applicable (observational). Management included routine surgical follow-up.Main Outcome Measure(s)Occurrence of ≥1 missed outpatient appointmentNo-show rate (%) among patients with any missed visit.ResultsThe cohort (n = 308) was predominantly Hispanic/Latino (55.2%), with high prevalence of public insurance (61.0%), siblings (71.4%), and household instability (40.6%). Patients attended a mean of 12.0 appointments over 5.2 years of follow-up, with 46.1% missing at least one visit. Among those with ≥1 missed appointment, the mean no-show rate was 8.4%. Hierarchical logistic regression identified Black race, household instability, siblings, and pulmonology care as being associated with appointment no-show. In hierarchical linear regression among patients with ≥1 missed visit, older age at follow-up and greater surgical burden were associated with slightly lower no-show rates, with limited contribution from sociodemographic or care coordination factors.ConclusionsDisparities in appointment attendance may be driven by household-level and clinical complexity factors. Interventions supporting families facing household instability and high caregiving demands may help reduce missed outpatient plastic surgery visits.