The Association of Neighborhood Disadvantage with Surgical Outcomes and Follow-Up Adherence in Patients with Cleft Lip

Objective To assess the relationship between neighborhood-level social disadvantage, as measured by Area Deprivation Index (ADI) and Childhood Opportunity Index (COI), and postoperative outcomes and follow-up care after primary or secondary cleft lip repair. Design Retrospective cohort study. Setting Single academic tertiary care center. Patients, Participants A total of 171 pediatric patients (<18 years of age) with cleft lip with or without cleft palate (CL ± P) who underwent primary or secondary cheiloplasty from 2013 to 2022. Interventions Neighborhood deprivation was assessed during treatment using two composite measures of relative socioeconomic disadvantage, the ADI and the COI. Main Outcome Measures Postoperative outcomes and clinic follow-up adherence. Results Among the 171 total patients, there was only a moderate correlation between patients’ ADI and COI quintiles ( R 2 = 0.552, p < . 001). Among all patients, ADI and COI were found to be associated with significant delay in follow-up and public insurance type was found to be associated with increased loss to follow-up. Patients with public insurance undergoing primary and secondary repair were more likely to have postoperative no-show appointments and have younger age at time of procedure. Neither ADI or COI correlated with surgical complications nor hospital readmission within 30 days for primary or secondary repair patients. Conclusions Neighborhood-level social disadvantage indices were associated with delays in postoperative follow-up but were not associated with short-term surgical complications or readmissions following cleft lip repair. These indices may help identify patients who could benefit from targeted outreach and care coordination to improve follow-up adherence.