Cleft Lip/Palate and Craniofacial Multidisciplinary Team Effectiveness on Appropriate Surgery Timing and Improving Disparities

Introduction: Accessing the comprehensive care required to manage orofacial clefts is paramount, and this is often accomplished successfully through a multidisciplinary team approach. We reviewed our institutional cleft lip and palate database to assess what patient care aspects were impacted with the implementation of our multidisciplinary approach.

Methods: This was a retrospective, single-institution dataset with cleft palate (CP) +/- cleft lip (CL) repairs from 2010 to 2024. The team-based approach was implemented in January 2019. Using this date, we made our primary predictor by categorizing patients into groups that received their surgeries pre- and post-implementation of the team. Our outcomes included timing of CP repair, timing of ear tube placement, 30-day post-operative follow-up, among other factors. Demographic, risk factor, and outcome data were analyzed across approach categories using chi-square and t-tests. Multivariate logistic regression was used to evaluate the effects of the team-based approach on the stated outcomes.

Results: Of the 395 patients in the database, 281 underwent surgery before team implementation and 114 after. Among all CP +/- CL patients, the team-based approach was associated with a lower likelihood of delayed CP repair of greater than 12 months of age (aOR = 0.41, 95% CI: 0.24–0.70), a higher likelihood of attending 30-day surgical follow-up (aOR = 3.08, 95% CI: 1.30–7.31), and a greater likelihood of ear tubes being placed prior to (aOR = 39.82, 95% CI: 12.05–131.58) or the day of the palate repair (aOR = 7.62, 95% CI: 1.89–30.79). Belonging to an ethnicity other than non-Hispanic White or Hispanic was associated with delayed CP repair (aOR = 4.76, 95% CI: 2.47–9.16).

Conclusions: This single-institution retrospective review demonstrated that a multidisciplinary, team-based approach is associated with significant improvements in treatment milestones in CP patients, which has significant impact on downstream development. This study highlights how a multidisciplinary approach can help marginalized patients who might otherwise fall through the cracks of the healthcare system.