Characterizing Secondary Velopharyngeal Surgery in Children With Cleft Palate at an Academic Center

ABSTRACT Objective To identify factors associated with secondary surgery for velopharyngeal insufficiency in children following primary palatoplasty. Methods A retrospective review was conducted of children with cleft palate who were seen at a single academic center between August 2014 and April 2024 and underwent primary palatoplasty. Demographic and clinical data were collected, and the need for and number of secondary velopharyngeal surgeries were recorded. Univariate analyses and multivariate logistic regression were used to identify associated factors. Results Of 251 children who underwent primary palatoplasty, 27 (10.8%) required secondary velopharyngeal surgery. Univariate analyses revealed no association between secondary surgery and cleft type, presence of a syndrome, or timing of palatoplasty. Multivariate logistic regression controlling for race, insurance type, age at primary palatoplasty, and presence of 22q11.2 microdeletion syndrome revealed private insurance was associated with decreased odds of secondary velopharyngeal surgery (OR = 0.230, 95% CI: 0.069–0.765, p = 0.017), whereas Asian race was associated with increased odds (OR = 5.853, 95% CI: 1.105–30.998, p = 0.038). Among those requiring velopharyngeal surgery, 74.1% underwent one procedure and 25.9% underwent two. The presence of 22q11.2 microdeletion syndrome was significantly associated with needing two surgeries ( p = 0.042), while female sex was associated with requiring only one surgery ( p = 0.006). Conclusions Clinical and sociodemographic factors were predictive of secondary velopharyngeal surgery following primary palatoplasty, with different risk factors associated with the need for more than one procedure. Larger studies are warranted to corroborate these findings and guide risk stratification and family counseling. Level of Evidence 4.