SA3 - Determinants of Missed Clinic Visits in Children With Cleft Lip and Palate: A 10-Year Retrospective Analysis

Abstract: Statement of the Problem: Children with cleft lip and palate (CLP) require coordinated, longitudinal multidisciplinary care extending from infancy through adolescence. Consistent outpatient follow-up with plastic surgery providers is essential to optimize surgical timing, monitor development, and address complications. However, missed appointments remain a persistent barrier to effective care delivery and may contribute to delays in treatment and worse outcomes. While social determinants of health are known to influence healthcare utilization, limited data exist examining factors associated with appointment non-adherence specifically in the CLP population. This study aims to identify sociodemographic and clinical predictors of missed outpatient plastic surgery appointments among children with CLP.

Methods: A retrospective chart review was conducted at a single urban tertiary children's hospital, including patients with CLP who underwent cleft lip repair between January 2015 and August 2025. Inclusion required at least 5 outpatient plastic surgery visits during the study period; out-of-state patients were excluded to ensure accurate follow-up capture. Data collected included outpatient appointment attendance, as well as sociodemographic variables (sex, race/ethnicity, primary language, religion, siblings, area deprivation index, number of addresses) and clinical variables (timing of operations, duration of follow-up, comorbidities, and subspecialty care involvement).

Method of Data Analysis: The cohort included 308 patients followed over a 10-year period, with a mean follow-up duration of 5.2 years. Outcomes were (1) occurrence of at least 1 missed outpatient appointment and (2) no-show rate among patients with any missed visit. Descriptive statistics were used to summarize cohort characteristics. Hierarchical logistic and linear regression models were constructed using a four-block approach to identify predictors of missed visits and no-show rates. Statistical significance was defined as P < .05.

Results: The cohort was predominantly Hispanic/Latino (55.2%), with high rates of public insurance (61.0%), siblings in the household (71.4%), and household instability (40.6%). Patients attended a mean of 12.0 outpatient visits over the study period, with 46.1% missing at least 1 appointment. Among those with missed visits, the mean no-show rate was 8.4%.

Hierarchical logistic regression identified Black race (OR 9.25, P = .012), household instability (OR 4.01, P = .002), presence of siblings (OR 2.52, P = .003), and involvement with pulmonology care (OR 3.45, P = .013) as independent predictors of having at least 1 missed appointment. Among patients with missed visits, hierarchical linear regression demonstrated that older age at follow-up (β -0.005, P < .001) and greater operative burden (β -0.007, P = .022) were associated with slightly lower no-show rates.

Conclusions: Disparities in outpatient appointment adherence exist among children with CLP. Initial missed visits appear to be driven largely by social and household-level factors, while patterns of repeat non-adherence are less strongly influenced by these variables. These findings highlight the importance of addressing social determinants of health in this population. Targeted interventions, such as automated appointment reminders and enhanced care coordination, may help reduce missed visits and improve continuity of care.


References:

1. Lynn JV, Ranganathan K, Bageris MH, Hart-Johnson T, Buchman SR, Blackwood RA. Sociodemographic Predictors of Missed Appointments Among Patients With Cleft Lip and Palate. Cleft Palate Craniofac J. 2018;55(10):1440-1446. doi:10.1177/1055665618764739

2. Wagner CS, Barnett SL, Romeo D, et al. Sociodemographic Factors Predict Long-Term Attrition from Multidisciplinary Cleft Clinic. Cleft Palate Craniofac J. 2025;62(6):1003-1010. doi:10.1177/10556656241234804