{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:57:24Z","timestamp":1790740644017,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cleft lip and\/or palate (CL\u00a0\u00b1\u00a0P) constitutes a significant portion of the global surgical burden. Patients in low\u2010 and middle\u2010income countries (LMICs) face disproportionate barriers that result in delayed surgical repair, worse long\u2010term outcomes, and increased morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to identify patient\u2010reported barriers and demographic characteristics associated with delayed CL\u00a0\u00b1\u00a0P surgery in LMICs where Operation Smile provides surgical care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective chart review of patients treated by Operation Smile between 2021 and 2024 was conducted. Variables included patient demographics, socioeconomic information, and self\u2010reported barriers to care. Delayed repair was defined as greater than 9\u00a0months for cleft lip and 18\u00a0months for cleft palate. Data were analyzed using chi\u2010squared and t\u2010tests. Significant variables then underwent uni\/multivariate logistic regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six hundred and sixty\u2010eight patients were included, of which 339 (50.7%) underwent lip repair and 329 (49.3%) underwent palate repair. The most common patient\u2010reported barrier was surgical cost (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0561 and 84.0%). On multivariate regression, increased maternal age significantly increased odds of delayed surgery (OR\u00a0=\u00a01.03[1.003, 1.07] and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.04) and maternal postsecondary education decreased odds among lip repair patients (OR\u00a0=\u00a00.22[0.05, 0.77] and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.03). For palate repair, maternal age (OR\u00a0=\u00a01.05[1.01, 1.09] and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02) and surgical cost (OR\u00a0=\u00a02.85[1.42, 5.71] and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.003) increased odds of delay, whereas paternal university\u2010level education decreased odds (OR\u00a0=\u00a00.15[0.02, 0.81] and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Surgical cost is a primary barrier to timely CL\u00a0\u00b1\u00a0P repair among patients in LMICs. Higher education among parents is associated with lower odds of delay. These barriers can inform global surgical organization strategies to improve access for patients at risk of delay.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.12469","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T22:19:11Z","timestamp":1739830751000},"page":"664-674","source":"Crossref","is-referenced-by-count":10,"title":["Barriers to timely primary cleft surgery in patients treated by an international cleft\u2010focused NGO across 18 countries"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9053-9840","authenticated-orcid":false,"given":"Alexander T.","family":"Plonkowski","sequence":"first","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery Children's Hospital Los Angeles  Los Angeles California USA"},{"name":"Operation Smile Incorporated  Virginia Beach Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Naidu","sequence":"additional","affiliation":[{"name":"Operation Smile Incorporated  Virginia Beach Virginia USA"},{"name":"Division of Plastic and Reconstructive Surgery Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4672-9414","authenticated-orcid":false,"given":"Greta L.","family":"Davis","sequence":"additional","affiliation":[{"name":"Operation Smile Incorporated  Virginia Beach Virginia USA"},{"name":"Division of Plastic Surgery Department of Surgery University of California San Francisco Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shervin","family":"Etemad","sequence":"additional","affiliation":[{"name":"Operation Smile Incorporated  Virginia Beach Virginia USA"},{"name":"Division of Plastic and Reconstructive Surgery Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel D.","family":"Otobo","sequence":"additional","affiliation":[{"name":"Operation Smile Incorporated  Virginia Beach Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M.","family":"Dwyer","sequence":"additional","affiliation":[{"name":"Operation Smile Incorporated  Virginia Beach Virginia USA"},{"name":"Department of Surgery University of Illinois Collage of Medicine  Peoria Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline A.","family":"Yao","sequence":"additional","affiliation":[{"name":"Operation Smile Incorporated  Virginia Beach Virginia USA"},{"name":"Division of Plastic and Reconstructive Surgery Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"William P.","family":"Magee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery Children's Hospital Los Angeles  Los Angeles California USA"},{"name":"Operation Smile Incorporated  Virginia Beach Virginia USA"},{"name":"Division of Plastic and Reconstructive Surgery Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(15)60160-x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-012-1732-8"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-015-3367-z"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-009-0198-9"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318254b2a2"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(14)70213-x"},{"key":"e_1_2_10_8_1","unstructured":"Our Vision2024. \u201cOperation Smile \u201d.https:\/\/www.operationsmile.org\/about-us\/our-vision#:~:text=Operation%20Smile%20was%20founded%20in. accessed August 6 2024."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2015.04.011"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2021.10.001"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000002656"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-3896-8"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000008334"},{"key":"e_1_2_10_14_1","first-page":"223","article-title":"Complications of Cleft Lip Surgery","volume":"3","author":"Wilhelmsen H. 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