The Role of Surgical Timing and Distance Traveled for Care for Patients Born With Cleft Palate

ObjectiveThis study evaluates the impact of travel distance and surgical timing on outcomes in patients undergoing palate surgery.DesignA retrospective cohort study analyzing patient data from electronic medical records. Univariate and Kruskal-Wallis analyses assessed associations between distance, timing, and outcomes.SettingA single academic, American Cleft Palate Craniofacial Association -approved tertiary craniofacial center in North Carolina.Patients, ParticipantsOne hundred and ninety-eight patients who underwent palate surgery from 2016 to 2023. Exclusion criteria included age >12 years, submucosal clefts, out-of-state residence, and lack of follow up.InterventionsPalate surgery categorized as early (<11 months), standard (11-13 months), or late (>13 months).Main Outcome Measure(s)Age at first craniofacial visit, age at surgery, time between visit and surgery, emergency department (ED) visits within 30 days of surgery, and incidence of velopharyngeal insufficiency (VPI) or speech therapy referral by age 3.ResultsMedian age at palate surgery was 10.1 months. Increased distance was significantly associated with increased age at clinic presentation (<i>P</i> = .042) and surgery (<i>P</i> = .041), but not increased time between first visit and surgery (<i>P</i> = .811). Earlier surgery was associated with reduced ED visits (<i>P</i> = .0159) and speech therapy referrals (<i>P</i> = .0255). VPI incidence was 11.4%, with no significant correlation to timing or distance.ConclusionsIncreased travel distance is associated with later primary palate surgery. Addressing geographic disparities is crucial to improving patient outcomes.