Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Derek Steinbacher

Second Advisor

Peter Gruber


Purpose: This study examined the impact of patient race or ethnicity on the likelihood of experiencing delays to surgery, post-operative surgical complications, or prolonged hospital stays following primary cleft lip (CL) repair.Methods: Patients who underwent CL repair were identified from two large national databases: the Kids Inpatient Database (KID) and the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Primary outcomes were defined as treatment after 6 months of age, the presence of any surgical complication, and a hospital stay greater than 1 day. Chi-squared analyses were performed to compare outcomes across patients of different race/ethnicity, followed by multivariable logistic regression to adjust for various demographic and social factors. Secondary analyses assessed the impact of race/ethnicity on hospital charges, and compared results across the KID and NSQIP databases. Results: There were 10,844 patients included in the study; 4917 patients from NSQIP, and 5927 from KID. Both databases showed significant differences (p < 0.001) in the likelihood of experiencing delayed surgery, complications, and prolonged hospital stay among patients of different race/ethnicity. Delays in care were highest among Hispanic (OR 1.22 – 3.86) and Asian/Pacific Islander (OR 2.26 – 4.67) patients, complications highest among Black (OR 1.28 – 2.11) and Hispanic (OR 1.59 – 2.11) patients, and prolonged stays highest among Other (OR 2.27-3.67) patients. Multivariable regression showed a strong confounding influence of various patient factors (p<0.001), with a particularly strong relationship between baseline pre-operative health status and each of the primary study outcomes. Conclusion There are significant differences in the likelihood of experiencing of delays, complications, and prolonged hospital stays among patients of different race or ethnicity. Advocacy efforts to ameliorate disparity in early infant health may subsequently improve health outcomes in CL repair.


This is an Open Access Thesis.

Open Access

This Article is Open Access