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Patient Loss to Follow-up After Upper Extremity Surgery: A Review of 2,636 Cases
Yoseph A Rosenbaum, MD; Kanu S Goyal, MD; Alex C DiBartola, BS; Hannah K Fox, BS; Yoni M Blau, MD; X Shawn Liu, BS
The Ohio State University, Columbus, OH
Introduction: Post-surgical follow-up is a vital part of caring for orthopaedic patients. The purpose of this study is twofold; first, to determine the incidence of post-operative patient loss to follow-up following Hand and Upper Extremity surgery, and second to identify factors that can help to identify patients at elevated risk of loss to follow-up. We hypothesize that there will be a correlation with loss to follow-up and demographic patient variables in a surgical hand and upper extremity practice.
Methods: 2,834 surgical cases (2,467 patients) were retrospectively reviewed. Inclusion criteria were: surgery staffed by an attending of the sponsoring institution, all procedures including elective and non-elective. Exclusion criteria were patients: who are prisoners, scheduled to follow up st outside institutions, still in follow-up, who underwent bedside procedures, died before follow-up was complete, have Veterans Association Insurance or unknown insurance status at the time of billed procedure. Charts were reviewed for compliance with post-operative follow-up. Demographic variables including insurance type, length of follow-up period, age, and gender were analyzed to determine correlation with follow-up. Variables were described with proportions and compared using logistic regression analysis. Odds ratios and confidence intervals were calculated with a p-value ≤0.05 signifying statistical significance.
Data and results: 2,834 surgical cases (2,467 patients) were identified in the study period. 2,636 cases (2,277 patients) met inclusion and exclusion criteria. Overall loss to follow-up rate was 29%. Patients lost to follow-up based on insurance type were 19% for Worker’s Compensation, 23% for Medicare, 24% for private insurance, 41% for Medicaid, and 49% for self-pay. All of these groups were significantly different (p<0.05) when compared to privately insured patients when adjusted to the other variables, except worker’s compensation (p=0.10). Patients with expected short term follow-up were lost at a 27% rate. When compared to short-term follow-up, expected mid-term and long-term follow-up patients were lost at 36% and 21% rates respectively (p=0.005, p=0.019). Patients under 30 years of age were lost to follow-up at a 44% rate when compared to patients 30-64 years old (28%, p<0.0001) and 65 and older (16%, p<0.0001). Males had a higher rate of loss to follow-up, 35% compared to females (24%, p<0.0001).
Discussion: Multiple demographic variables may identify high risk patients, which could allow surgeons to proactively educate them on the importance of follow-up. This could improve patient care and outcomes for post-surgical patients. Risk factors included: Self Pay, Medicaid, and Medicare insurance, younger age, midterm follow-up period, and male gender.
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