Cleft Lip and Palate Care: A Healthcare Cost and Utilization Project Analysis

Abstract

Increasing emphasis on reduction of healthcare costs has caused rates of outpatient cleft lip and palate-related procedures to rise. This study aims to describe patient and hospital characteristics associated with cleft repair and related surgeries and to assess differences in these characteristics against those undergoing inpatient cleft procedures. Data was collected from the 2016 to 2018 National Inpatient Sample (NIS) and the 2016 to 2018 Nationwide Ambulatory Surgery Sample (NASS) from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ). The databases were queried for International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and Current Procedural Terminology (CPT) codes, respectively, describing cleft lip and palate-related procedures. Variables described were categorized into 2 main groups of patient demographics and hospital characteristics. A total of 271 patients were included from the NIS and 3122 patients from the NASS. In both settings, the most common insurance used for cleft lip surgeries was Medicaid (46.7% vs 50.7%); the same was true for cleft palate (50.7% vs 53.5%). The distribution of zip code-based income quartiles was similar between settings for both cleft procedures. The most common location and teaching status of the hospitals was urban, teaching hospitals. This study demonstrates that patient and hospital characteristics are similar between inpatient and outpatient cleft surgeries. Patients were primarily in the 2 lower income quartiles and enrolled in Medicaid. More granular studies defining the social determinants of health in the cleft lip and palate populations may improve care for these patients.