Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, USA.
Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, USA; Faculdade de Medicina, Universidade de São Paulo, Brazil.
J Plast Reconstr Aesthet Surg. 2022 Jul;75(7):2375-2386. doi: 10.1016/j.bjps.2022.02.009. Epub 2022 Feb 21.
Many patients worldwide are unable to access timely primary repair of cleft lip and palate. The aim of this study was to assess patient-perceived barriers to accessing timely cleft lip and palate repair across Brazil.
A 29-item questionnaire was applied to patients undergoing surgery for cleft lip and/or palate across five contrasting sites in Brazil from February 2016 to November 2017. Differences in patient timelines, demographics, and patient-reported barriers were compared by region. A multivariate logistic regression was used to determine predictors of delayed care.
Of 181 patients, 42% of patients received timely primary surgical repair. The age of the patient at the interview was 82 months (standard deviation [SD] 107) and 52% were male. The majority of delays occurred between diagnosis and primary surgical repair. The mean number of barriers to accessing timely surgical care cited by each patient was 3.77. The most common barrier was perceived "lack of hospitals that provided the surgery in my area" (48% (n = 86)). Univariate logistic regression showed increased odds of receiving late care in the state of Amazonas (odds ratio [OR] 2.91; 95% confidence interval [CI] 1.07-7.96; P = 0.037) or Para (OR 4.46; 95% CI 1.09-19.70; P = 0.037). Multivariate logistic regression determined predictors of delayed care to be female sex (OR = 2.05; 95% CI 1.05-3.99; P = 0.035) and perceived poor availability of care (OR = 0.045; 95% CI 1.02-4.37; P = 0.045).
The majority of patients in Brazil are not receiving timely primary repair of their clefts. Improvements in the coordination of care, patient education and patient empowerment are required.
全球许多患者无法及时接受唇腭裂的初次修复。本研究旨在评估巴西各地患者在获得唇腭裂及时修复方面所面临的障碍。
2016 年 2 月至 2017 年 11 月，在巴西五个不同地区接受唇裂和/或腭裂手术的患者，应用了一份包含 29 个问题的调查问卷。比较了不同地区患者的治疗时间、人口统计学特征和患者报告的障碍差异。采用多变量逻辑回归分析确定延迟治疗的预测因素。
181 名患者中，42%的患者接受了及时的初次手术修复。接受访谈时患者的年龄为 82 个月（标准差 [SD] 107），52%为男性。大多数延迟发生在诊断与初次手术修复之间。每位患者报告的获得及时手术治疗的障碍平均为 3.77 个。最常见的障碍是认为“我所在地区缺乏提供手术的医院”（48%（n = 86））。单因素逻辑回归显示，在亚马逊州（优势比 [OR] 2.91；95%置信区间 [CI] 1.07-7.96；P = 0.037）或帕拉州（OR 4.46；95% CI 1.09-19.70；P = 0.037）接受晚期治疗的可能性增加。多因素逻辑回归确定延迟治疗的预测因素为女性（OR = 2.05；95% CI 1.05-3.99；P = 0.035）和感知到的治疗可用性差（OR = 0.045；95% CI 1.02-4.37；P = 0.045）。
巴西大多数患者未及时接受唇腭裂的初次修复。需要改善护理协调、患者教育和患者赋权。
