Determinants of Delayed Primary Palatoplasty at a Comprehensive Cleft Care Centre in India: Status, Limitations and the Challenges

Objective To investigate the factors contributing to delayed primary palatoplasty (beyond 18 months of age) among individuals undergoing surgery at a comprehensive cleft care centre in South India. Design Retrospective observational study. Setting Tertiary-level comprehensive cleft care centre. Patients, Participants Medical records of 720 patients who underwent primary palatoplasty at our unit over a 10-year period were reviewed. Following the exclusion criteria, delayed repair occurred in 295 patients (42.2%). The reasons for delay were inadequately documented in 115 cases. Therefore, 180 patients with complete documentation were included in the final analysis. Intervention Primary palatoplasty using standard surgical techniques as per the institutional protocol. Main outcome measures Identification and categorization of the reasons for delay in primary palatoplasty into medical and socio-economic factors. The association between cleft phenotype and reasons for delay was assessed. Results The data of 180 participants (61.01% of the delayed repair cohort) were evaluated. Socio-economic factors were the most common contributors to delay. Among medical factors, anaemia, poor weight gain and congenital heart disease were predominant. Caregiver's lack of engagement significantly contributed to the delay in the socio-economic category. Isolated cleft palate demonstrated a higher association with diagnostic delay. A statistically significant association was noted between cleft phenotype and reasons for delay ( P = .05). Conclusions Delayed primary palatoplasty remains prevalent and is driven largely by socio-economic constraints and awareness gaps. Strengthening early identification and structured referral pathways may improve timely access to cleft care in resource limited settings, facilitating timely access to cleft care.