From Repair to Reply: Characterizing Utilization Patterns and Timing of Patient Electronic Communication in Cleft Care

PURPOSE: Patient electronic communication (PEC) supports patient engagement and continuity of care but remains understudied in pediatric cleft lip and/or palate (CLP). This study characterizes perioperative PEC use among pediatric patients undergoing CLP surgery and identifies factors associated with communication burden. METHODS: A retrospective study analyzed PECs from pediatric patients undergoing CLP surgery at a tertiary craniofacial center from January 2023 to December 2024. Portal messages from surgical scheduling through 90 days postoperatively were extracted and categorized by volume and content. Multivariable regression models evaluated predictors of PEC use and volume, adjusting for demographics, cleft phenotype, syndromic status, surgical history, Social Vulnerability Index (SVI), and perioperative clinical factors. RESULTS: Among 246 patients, 77.6% (n=191) sent at least 1 PEC, generating 642 messages (mean: 2.6±3.0). The majority occurred preoperatively (60.4%). Dominant content included logistical coordination (31.0%), feeding/nutrition (15.7%), and orthodontic issues (14.0%). On multivariable analysis, increased PEC volume was independently associated with longer hospital length of stay (β=0.62, P<0.01) and greater cumulative prior surgeries (P<0.01). Higher ASA classification (P=0.03) and 30-day readmission (P<0.01) were associated with decreased PEC volume. While overall SVI did not predict total volume, household vulnerability was associated with increased wound care inquiries (P=0.03). CONCLUSION: PEC is highly prevalent among families of children undergoing CLP surgery, with nearly three-quarters using portal messaging. Most communication occurs preoperatively, suggesting PEC is driven more by anticipatory uncertainty and logistical preparation than postoperative recovery. Message categories reflect distinct unmet needs-logistics, feeding, devices, and wound care, highlighting opportunities for targeted perioperative education.