Predictors of Poor Speech Outcomes Following Primary Palatoplasty for Patients with Cleft Palate: Do Social Determinants of Health Impact Velopharyngeal Insufficiency?

INTRODUCTION

Velopharyngeal insufficiency (VPI) is an unfavorable outcome of primary palatoplasty. Clinical and surgical risk factors for VPI are well described, yet the impact of social determinants of health (SDoH) on VPI is less understood. This study aimed to estimate the effect of income, ethnicity, and geographical location on VPI.

METHODS

Non-syndromic patients who had primary palatoplasty at British Columbia Children's Hospital between 2005 and 2015 were retrospectively reviewed. Patient demographics, including income, ethnicity, and distance to hospital were collected, as well as primary palatoplasty details, VPI diagnosis, and any secondary speech surgery. Logistic regression models were used to examine associations with VPI.

RESULTS

A total of 209 patients were included: 30% (n = 63) developed VPI. Complete cleft palate was a significant predictor of VPI (odds ratio (OR) 4.35, P ≤ .001). Indigenous identity, sex assigned at birth, average income, and distance to the hospital were not predictors of VPI. For those with complete cleft palate, there was a 24% greater likelihood of developing VPI for every month older the patient was at the time of initial palate repair (OR 1.27, P = .018).

CONCLUSIONS

Cleft palate severity and age at primary palatoplasty for patients with complete cleft palate had the largest effect on VPI. SDoH factors (income and geographical location) were not associated with VPI; however, there was a trend between Indigenous identity and the development of VPI. The effect of Indigenous identity was limited by incomplete data and may be an area of future research. These findings are reassuring for a multidisciplinary clinic with dedicated social work support in a public healthcare system.