Our Summary

This research paper examines how expanding Medicaid under the Affordable Care Act (ACA) impacted the timing of surgeries for children with cleft lip and palate, particularly in terms of racial disparities. The study analyzed data from 44 children’s surgery centers throughout the U.S. and found that Medicaid expansion actually led to a 9% increase in delayed cleft lip surgeries, causing an average delay of 16 days. These delays were more common in non-White patients. However, the timing of palate repairs was not significantly affected by Medicaid expansion, nor were there racial disparities in palate repair. The study emphasizes the need to monitor the unintended side effects of large health system changes, especially when it comes to disadvantaged groups. It also calls for more research to determine why these delays are happening and how to prevent them. The paper concludes by stressing the importance of making sure health care policies and interventions don’t unintentionally increase health disparities.

FAQs

  1. Did the expansion of Medicaid under the ACA affect the timing of surgeries for children with cleft lip and palate?
  2. Was there a noticeable racial disparity in the delay of cleft lip surgeries following Medicaid expansion?
  3. Was the timing of palate repairs significantly affected by the expansion of Medicaid?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cleft lip repair is to follow all pre-operative and post-operative instructions given by the surgical team. This can include guidelines on medications, wound care, and follow-up appointments. Additionally, maintaining good oral hygiene and avoiding smoking or alcohol consumption can help promote successful healing after the surgery. It’s also important for patients to communicate openly with their healthcare providers about any concerns or complications they may experience during the recovery process.

Suitable For

Patients with cleft lip and palate are typically recommended to undergo cleft lip repair surgery. This surgery is usually recommended for infants between 3 to 6 months of age, although it can be performed at a later age as well. Patients with cleft lip are often recommended for surgery to improve their feeding, speech, and overall appearance. Additionally, early cleft lip repair can prevent potential social and psychological issues associated with having a visible facial difference. It is important for patients with cleft lip and palate to receive timely and appropriate care to ensure optimal outcomes and quality of life.

Timeline

  • Before cleft lip repair:
  1. Patient is born with a cleft lip, which may be detected during prenatal ultrasound or at birth.
  2. Patient undergoes initial evaluation by a pediatrician, plastic surgeon, or other healthcare provider to determine the severity of the cleft lip and plan for surgical repair.
  3. Patient may require feeding interventions, speech therapy, and dental care to address issues related to the cleft lip.
  4. Patient and family receive counseling and support to prepare for the surgery and recovery process.
  • After cleft lip repair:
  1. Patient undergoes cleft lip repair surgery, which typically takes place within the first few months of life.
  2. Patient may experience pain, swelling, and discomfort following the surgery, which can be managed with pain medication and proper wound care.
  3. Patient may need to follow a special diet or feeding plan during the recovery period to ensure proper healing.
  4. Patient and family receive follow-up care and monitoring to track healing progress, address any complications, and plan for future surgeries or treatments (such as cleft palate repair).
  5. Patient may require ongoing care from a multidisciplinary team of healthcare providers, including plastic surgeons, speech therapists, dentists, and psychologists, to address the physical, emotional, and developmental needs associated with cleft lip and palate.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cleft lip repair include:

  1. How soon should my child undergo cleft lip repair surgery?
  2. What are the potential risks and complications associated with cleft lip repair surgery?
  3. Will my child require multiple surgeries for cleft lip repair?
  4. What is the expected recovery time after cleft lip repair surgery?
  5. Are there any special precautions or aftercare instructions I should follow after the surgery?
  6. How will cleft lip repair surgery impact my child’s speech and feeding?
  7. Will my child need additional therapy or treatments after cleft lip repair surgery?
  8. What is the success rate of cleft lip repair surgery?
  9. Are there any long-term effects or considerations I should be aware of after cleft lip repair surgery?
  10. How can I best support my child through the cleft lip repair process and recovery?

Reference

Authors: Barrero CE, Kavanagh NM, Pontell ME, Salinero LK, Wagner CS, Bartlett SP, Taylor JA, Swanson JW. Journal: J Craniofac Surg. 2023 Oct 1;34(7):2116-2120. doi: 10.1097/SCS.0000000000009524. Epub 2023 Jul 26. PMID: 37493139