Hospital Admissions for Cleft Lip and Palate in Brazil (2008–2024): Temporal Trends, Racial Disparities, and Regional Efficiency Clusters

Objective To describe temporal trends in hospital admissions for cleft lip and/or palate (CL/P) repair in Brazil, assess the COVID-19 pandemic impact, examine racial and demographic disparities in length of hospital stay (LOS), and identify regional efficiency patterns. Design Retrospective ecological study using nationwide hospital admission data. Setting Brazilian Unified Health System (SUS), covering public sector inpatient procedures. Participants: 98,998 hospital admissions for CL/P surgical repair from 2008 to 2024. Interventions None (observational analysis of primary/secondary surgical repairs). Main Outcome Measures: Annual admission volumes and trends (annual percent change via Prais–Winsten regression); LOS by race/color (Kruskal–Wallis test); state-level clustering (K-means) based on volume, sex distribution, and mean LOS. Results Male predominance (ratio 1.36:1); 70% repairs under age 5. Stable volumes until 33% decline in 2020, with incomplete recovery. Significant racial disparities in LOS ( p = .0007), longer among Brown (Parda) and Indigenous children. Heterogeneous state trends; four clusters identified, with São Paulo high-volume/moderate-stay vs. northern low-volume/prolonged-stay. Conclusions Brazil has robust CL/P surgical capacity, but racial and profound regional disparities persist, compromising equity and efficiency. Targeted investment in northern regions, decentralized expertise, and standardized protocols are needed to reduce inequities.