Evaluation of Orthopedic Trauma Surgery Follow-up and Impact of a Routine Callback Program

Abstract

A high rate of patients lost to follow-up is a common problem in orthopedic trauma surgery. This adversely affects the ability to produce accurate clinical outcomes research. The purpose of this project was to (1) evaluate the rate of loss to follow-up at an academic level I trauma center; (2) identify the patient-reported reasons for loss to follow-up; and (3) evaluate the efficacy of a routine patient callback program. All patients who underwent surgery in the orthopedic trauma division of the University of Virginia Medical Center from April 1, 2014, to September 30, 2014, and did not complete their postoperative clinic follow-up were analyzed. The characteristics of these patients were evaluated, and the primary reason for not completing the recommended follow-up was identified. All patients were then offered additional orthopedic follow-up at the time of contact. Of the 480 patients who met the inclusion criteria, 41 (8.5%) failed to complete the recommended postoperative follow-up course. The most common reason for being lost to follow-up was feeling well and not having the need to be seen (46.3%). Only 6 (14.6%) of the 41 patients requested follow-up care at the time of contact. The lost to follow-up rate in this study, 8.5%, was considerably lower than that previously reported, but patient characteristics were consistent with those of prior studies on this subject. The low lost to follow-up rate may reflect a difference in geographic location or patient population. The patient callback program had a low yield of patients requesting additional follow-up after being contacted. [Orthopedics. 2017; 40(2):e312-e316.].

Lost to follow-up: Challenges to conducting orthopaedic research in South Africa

“…Patients who do not experience any postoperative complications may potentially not be likely to travel long distances and spend time away from work just to confirm their personal perception that their treatment was successful. In support of this, Casp et al [3] reported that patients who reported feeling well did not see the need to attend follow-up visits. They concluded that the lack of follow-up results from a voluntary decision by the patient not to seek further medical care, rather than the failure of logistics or scheduling to provide the patient with adequate care and followup appointments.…”

“…A recent study reported that 46.3% of all patients who failed to follow up reported 'feeling good' and hence did not feel the need to follow up, subsequently failing to report for scheduled follow-up visits. [3] When these reported factors are combined with long travel distances and poverty, the likelihood of return is further decreased. [3] Lack of follow-up can often lead to skewed results and influence study outcomes and validity.…”

“…[3] When these reported factors are combined with long travel distances and poverty, the likelihood of return is further decreased. [3] Lack of follow-up can often lead to skewed results and influence study outcomes and validity. [3,4,9,10] This further creates the perception of poor study design, management and execution or poor performance of the researchers or clinicians, with the impression that patients were dissatisfied with their care and chose to visit alternative clinicians.…”

“…[3] Lack of follow-up can often lead to skewed results and influence study outcomes and validity. [3,4,9,10] This further creates the perception of poor study design, management and execution or poor performance of the researchers or clinicians, with the impression that patients were dissatisfied with their care and chose to visit alternative clinicians. [10] Although a genuine concern in private settings both locally and abroad, the possibility of a patient utilising the public healthcare system in SA failing to report for follow-up because of dissatisfaction with a primary healthcare provider is unlikely, because of the setup of the public healthcare system.…”

Loss to follow-up among patients diagnosed with spinal tuberculosis at a tertiary hospital in Western Cape Province, South Africa: A retrospective cohort study

“…However, it is even more likely that baseline characteristics included in the current analysis explain less variation in LTFU than other, unmeasured variables -variables not reliably available through retrospective record review. For example, smoking, [28][29][30]32,33] substance abuse, [28,29,33,40] feeling well [24,40,41] and a low level of education [17,31,33,40] have all been linked with loss to follow-up in TB-and trauma-related studies. Furthermore, the previously identified role of low income or poverty [28,31] may be particularly important in the current population, most of whom come from a low socioeconomic background, are unable to work for extended periods of time, and may have to weigh the expense of travel to the hospital against competing costs such as food.…”