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.