May 31, 2019 – A new study documents racial disparities among children undergoing surgery to repair cleft palate, including a higher risk of complications in African-American children, reports the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
"Patient race may play a significant role in both primary and revision cleft palate repair," according to the new research by ASPS Member Surgeon Derek Steinbacher, MD, DMD, and colleagues of Yale School of Medicine. "While many factors may contribute to disparities in care, delayed age at treatment may be particularly impactful, predisposing patients to more adverse sequelae, increased length of stay, and higher hospital costs."
National Database Shows Racial/Ethnic Disparities in Cleft Palate Surgery
Using a national database of hospitalizations in children (the Kids' Inpatient Database), the researchers analyzed patient characteristics and outcomes of cleft palate surgery among children in six racial/ethnic groups: approximately 3,500 White, 1,400 Hispanic, 400 African-American, 400 Asian/Pacific Islander, and 500 "other" race/ethnicity.
African American and Hispanic patients were more likely to be in the lowest level of income, while African American children were most likely to have Medicaid coverage. African American and Hispanic children underwent initial cleft palate surgery at an older age (average 33 and 35 months, respectively), compared to White patients (29 months). African American children also had a higher rate of emergency admission to the hospital (7.3 versus less than 2.6 percent).
Overall, White patients had fewer complications than non-White patients. African American patients had more total complications than other racial/ethnic groups, including higher complication rates after initial and revision cleft palate repair. Some specific types of complications also varied by racial/ethnic group.
The study also showed disparities in the costs of cleft palate surgery. "Overall, White patients accrued the lowest costs, while African-American and Hispanic patients accumulated $3,000 to $4,000 more per surgery," Dr. Steinbacher and coauthors write.
Why are complication rates higher in children from minority racial/ethnic groups? Socioeconomic factors could play a role, with lower incomes and higher Medicaid rates linked to increased environmental stress, lower birthweights, and delayed access to care. Many of the same factors could be related to delays in cleft palate repair.
African American children were less likely to have cleft lip, which might have contributed to delays in surgery. "This may explain why Hispanic patients, despite similar socioeconomic indicators as African-American patients, had relatively low complication rates," the researchers write. They note the importance of considering possible provider bias and discrimination, which have been shown to affect a variety of health outcomes.
"Our studies suggest that patients from minority populations in the US incur higher costs and experience higher complications rates than patients of other racial backgrounds, likely stemming from delayed care," Dr. Steinbacher comments. "We believe that in addition to influencing the management of cleft palate, this research gives needed attention to the social determinants of health—an influential yet understudied component of surgical care that is important for plastic surgeons of all specialties to consider and understand."
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For more than 70 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
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