Timing of surgery for primary repair of cleft lip and/or palate on educational attainment at age 7 years: a birth cohort study using linked administrative data for England

ObjectiveTo examine the relationship between timing of primary cleft surgery and educational outcomes in children at age 7 years. DesignBirth cohort study. SettingNHS hospitals and state-maintained schools in England. Study populationSingleton births (including those with additional congenital anomalies) in hospital episodes statistics (HES) between September 1, 2007, and August 31, 2012, with ICD-10 orofacial cleft diagnostic codes recorded in HES before their second birthday and OPCS-4 orofacial cleft intervention and procedure codes recorded in HES before their fifth birthday. Main exposureTiming of primary cleft surgery for children with any cleft type involving the palate and/or lip. Main outcomesStandardised Key stage 1 (KS1) Reading and Maths scores. ResultsOf 3919 children, 828 (21.1%) had ICD-10 codes indicating a cleft lip and 3091 (78.9%) had ICD-10 codes indicating a cleft involving the palate (palate only or palate and lip). Over one third of these children (1455 of 3919; 37.2%) had an additional congenital anomaly. Of 828 children with a cleft lip only, 125 (15.1%) received lip repair surgery after 6 months. Of 3091 children with a cleft involving the palate, 560 (18.1%) received palate repair surgery after 12 months. For children with cleft lip only, there was no evidence of an association between age at first lip repair surgery and the probability of achieving the expected level in maths or reading at KS1. For children with any cleft involving the palate, those who were older when they received surgery were less likely to achieve the expected level in both subjects. ConclusionLate primary cleft palate repair surgery (after 12 months) is associated with a lower likelihood of achieving the expected level in Maths and Reading in KS1 at age 7 years.