SA3 - Reduced Access to Secondary Rhinoplasty in Patients With Cleft Lip Is Associated With Public Insurance and Greater Socioeconomic Disadvantage

Abstract: Background: Patients with cleft lip often require secondary rhinoplasty to optimize functional and esthetic outcomes.^1,2 However, access to this procedure may be influenced by non-clinical factors such as insurance type and geographic proximity to surgical centers. In this study, we assess the association between socioeconomic contributors to healthcare with access to secondary rhinoplasty among patients with a history of cleft lip.

Methods: A retrospective cohort study of patients with a history of cleft lip at a single tertiary care center from 2010 to 2024 was conducted. Patient charts were reviewed to identify individuals with a history of cleft lip and to determine whether they underwent secondary cleft rhinoplasty. Socioeconomic variables including insurance type, Area Deprivation Index (ADI), percentage of households in the patient's ZIP code earning less than $100K annually, and distance from home address to the hospital (calculated using the Haversine formula) were collected. Logistic regression analysis was performed to evaluate associations between these factors and receipt of secondary rhinoplasty.

Results: A total of 907 patients met inclusion criteria, 180 (19.8%) of whom underwent secondary rhinoplasty for functional or esthetic concern. Among patients who underwent secondary rhinoplasty, 88 (48.9%) were female, compared to 370 (50.9%) in the control group (P = .232), with no difference in race/ethnicity (P = .123). Rhinoplasty was not significantly associated with syndromic status, with 10.0% of patients in the rhinoplasty group and 5.9% in the control group having a known syndrome (P = .05). There was no difference in race between the 2 groups (P = .098). After adjusting for age, sex, cleft severity, and syndromic status, the following factors remained significant: ADI (5.8 ± 1.79 in rhinoplasty cohort vs 5.5 ± 2.13 in control cohort; P < .001) and public insurance (57.2% vs 49.0%, P = .002). The % of households in the patient's ZIP code earning less than $100K was not significantly associated with rhinoplasty (36.0 ± 12.8 vs 37.9 ± 15.4, P = .102).

Conclusions: Higher ADI and public insurance status were significantly associated with lower likelihood of receiving secondary cleft rhinoplasty, suggesting that socioeconomic disadvantage may limit access to care. However, these are proxy measures, and further prospective studies incorporating patient-reported barriers and qualitative data are needed to better understand the underlying challenges.


References

Rohrich RJ, Benkler M, Avashia YJ, Savetsky IL. Secondary Rhinoplasty for Unilateral Cleft Nasal Deformity. Plast Reconstr Surg. 2021;148(1):133-143. doi:10.1097/PRS.0000000000008124

Liao D, Pereira N, Obayemi A Jr, Sclafani AP. Secondary Cleft Rhinoplasty. Facial Plast Surg Clin North Am. 2024;32(1):43-54. doi:10.1016/j.fsc.2023.06.003