Impact of neurodevelopmental disorders on surgical outcomes in patients with cleft lip and palate: A retrospective cohort study from the U.S. collaborative network.

Abstract

Patients with cleft lip and/or palate (CL/P) undergo multiple surgical interventions from infancy through adulthood. Neurodevelopmental disorders (NDD) occur more frequently in patients with CL/P than in the general population. We compared postoperative medical events, complications, and revision surgery rates between patients with CL/P with and without NDD. We hypothesized that patients with NDD would experience higher rates of postoperative adverse events. Data were obtained from the United States Collaborative Network within TriNetX. Patients diagnosed with cleft lip (CL) and/or cleft palate (CP) between 2010 and 2025 were stratified by NDD diagnosis using ICD codes. All patients who underwent at least one cleft-related surgical procedure were categorized by reconstructive stage using CPT codes. Cohorts were propensity score matched for age at surgery, sex, race, congenital syndromes, and cleft type. Outcomes included post-index medical events, postoperative complications, and revision surgery. Among the 22,011 patients with CL/P, 2525 had NDD. After matching, 2071 patients were included per cohort. Airway- and feeding-related adverse events were significantly higher in the NDD cohort across all procedure types (p≤0.03). Emergency department visits were more frequent following primary CL repair, primary and secondary CP repair, and rhinoplasty (p<0.01). Neurodivergent patients had higher rates of velopharyngeal insufficiency following primary and secondary CP repair and increased oronasal fistula formation after secondary CP repair. Revision surgery rates did not differ significantly between the groups. In CL/P, concomitant NDD is associated with increased postoperative medical events and complications without higher revision surgery rates, highlighting the need for tailored perioperative care.