Timeliness of Primary Surgery for Children with Orofacial Clefts Open Access

Abstract

Background: Information regarding use of team care for children with orofacial clefts (OFCs) and timeliness of primary surgical cleft repair in the United States is lacking.

Methods: This statewide, population-based study included children born with OFCs between 1998 and 2007 in Florida. Eligible children were identified by the Florida Birth Defects Registry and linked with inpatient records beyond the first year of life. Descriptive results were reported both by overall and stratified by cleft type (cleft lip with cleft palate (CLP), cleft lip (CL) and cleft palate (CP)) and by isolated and non-isolated OFCs. We fit Poisson regression models to assess the associations between use of team care and timeliness of primary surgery (12 months for CL and 18 months for CLP and CP).

Results: Analyses included 1,708 children with OFCs. The majority of children received team care (n= 1,577: 92.3%) and timely primary cleft surgery (n=1,633: 95.6%). Use of team care was not meaningfully associated with timelines of primary surgery, regardless of cleft type or isolated vs. non-isolated clefts.

Conclusion: The majority of children are receiving team care and timely primary surgery. Although team care was not associated with timeliness of primary surgery, it likely improves care of children with OFCs in other ways.

Table of Contents

Chapter 1: Literature Review……………………………………………………1

Part I: Introduction……………………………………………………………….1

Part II: Epidemiology of Orofacial Clefts…………………………………....1

I: Terminology…………………………………………………………..............1

II: Classification…………………………………………………………...........2

III: Prevalence Estimates in the United States………………………........2

Part III: Quality of Life, Timeliness of Primary Surgery and Team Care……….3

I: Quality of Life…………………………………………………………...........3

II: Timeliness of Primary Surgery……………………………………….......4

III: Team Care……………………………………………………………...........6

Part IV: Current Literature and Study Justification………………..........8

I: Team Care as an Exposure…………………………………………….........8

II. Timeliness of Primary Surgery as an Outcome………………….........9

III: Study Justification…………………………………………………..........10

Chapter 2:Background…………………………………………………….......11

Methods…………………………………………………………………………...12

Figure 1…………………………………………………………………………....15

Results………………………………………………………………………….....16

Table 1………………………………………………………………………….....18

Table 2………………………………………………………………………….....20

Table 3…………………………………………………….............................21

Discussion………………………………………………………………............22

Conclusion………………………………………………………………………..25

Appendix

Table 1……………………………………………………………………………..26

Table 2……………………………………………………………………………..27

References………………………………………………………………………...29

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	cleft and craniofacial team care clefts primary surgery
Committee Chair / Thesis Advisor	Howards, Penelope, Emory University
Committee Members	Cassell, Cynthia, CDC
Partnering Agencies	CDC

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