Characterizing Comprehensive Cleft Care in the United States: A National Inpatient Sample Study.

Abstract

Cleft lip and palate (CLP) are among the most common congenital craniofacial anomalies impacting feeding, speech, and facial appearance. Comprehensive management involves multidisciplinary care, including surgical interventions, orthodontics, speech therapy, and psychosocial support. This study examines demographic, clinical, and economic factors influencing hospital charges and outcomes associated with CLP management in the United States. Using ICD-10-CM/PCS codes and data from the National Inpatient Sample (NIS) for 2016 and 2017, this study included patients primarily or secondarily treated for combined CLP. Baseline demographics and outcomes were analyzed using descriptive statistics, and multivariable logistic regression was used to identify factors influencing non-home discharges and extended length of stay (LOS). The study population comprised 4205 patients (60.2% male and 39.8% female). The majority were White (44.3%) and Hispanic (29.3%). Most patients were privately insured (47.0%) or on Medicaid (42.7%). The mean cost of care was $13,291, and total hospital charges averaged $49,229, inflation adjusted. The average LOS was 1.981 days (SD=6.850), and 1.3% of patients experienced non-home discharges. Native American patients and those with higher risks of mortality showed higher odds of non-home discharge, whereas patients in the West had lower odds of non-home discharge. Those of unspecified racial background, treated at urban non-teaching hospitals, or with higher risks of mortality experienced higher odds of extended LOS. This study highlights sociodemographic and geographic disparities in CLP care. Addressing systemic barriers and standardizing care protocols are essential to improving outcomes and reducing financial burdens.