Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Mayur M. Desai

Second Advisor

Derek M. Steinbacher

Abstract

AbstractPurpose: This study examined the impact of patient race/ethnicity on the likelihood of experiencing delays to surgery, post-operative surgical complications, and prolonged hospital length of stay (LOS) following primary cleft lip (CL) repair. Methods: Patients who underwent CL repair were identified in the 2006-2012 Kids’ Inpatient Database. Primary outcomes were defined as treatment after 6-months-old, presence of any surgical complication, LOS >1 day, and total hospital charges. Multivariable analyses were performed to adjust for sociodemographic and clinical characteristics that might account for differences in outcomes. Results: There were 5927 eligible patients with cleft lip: 3724 White, 279 Black, 1316 Hispanic, 277 Asian/Pacific-Islander, and 331 other race/ethnicity. Across all outcomes, there were significant unadjusted differences (p<0.001) by race/ethnicity, with White children having the lowest odds of delayed surgery, complications, and prolonged LOS, and the lowest charges. Multivariable analyses suggested that differences in baseline health status may explain disparities in complication rates across race/ethnicity, as well as delays, prolonged LOS, and charge differences in Black and other patients. Even after adjusting for co-variates, however, significantly increased odds of delayed surgery and higher charges remained for Hispanic and Asian/PI patients. Conclusion There are significant differences in the odds of delays, complications, prolonged hospital stays, and total charges among CL patients of different race/ethnicity. Advocacy efforts to ameliorate disparity in early infant health may subsequently improve care outcomes.

Comments

This is an Open Access Thesis.

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