Looking Forward: A Systematic Review Assessing Risk Factors Predicting Orthopaedic Trauma “Loss to Follow-up”
Gregory J. Kirchner, Yehuda E. Kerbel, Andrew Kim, Matthew K. Stein, William H. Ryan, Samir Mehta
Abstract
Introduction Loss to follow-up is common after orthopaedic trauma and may disproportionately affect vulnerable populations. Therefore, the purpose of this study was to understand patient characteristics increasing risk of lack of follow-up after orthopaedic trauma. Methods The Medline and Cochrane Library databases were queried with combinations of MeSH terms and keywords related to patient compliance in orthopaedic surgery were used. Inclusion criteria were: 1) published in the English language; 2) described patients who underwent surgical treatment for a traumatic orthopedic injury; 3) recorded patient compliance for at least the first scheduled outpatient follow-up appointment; 4) reported characteristics associated with patients who failed to comply with outpatient follow-up or reported patient-cited reasons for failure to comply with outpatient follow-up. Data extracted included rate of follow-up, demographic characteristics (e.g., race/ethnicity and measures of socioeconomic status), patient-reported reasons for non-compliance, and patient-reported outcome measures. Results Nine studies representing 7,188 patients met the inclusion criteria. A total of 1,728 (24.0%) of patients were considered lost to follow-up over a range of 2 weeks to 2 years after surgery. Males, younger patients, current tobacco users, and uninsured or patients with government insurance plans were commonly lost to follow-up. Of 166 patients questioned for reasons for failure to follow-up, 31 (18.7%) cited distance or inconvenience as the primary reason. Meanwhile, 19 (11.4%) stated that they did not attend because they felt well. Conclusion Our review confirms that there is a high rate of follow-up non-compliance after orthopaedic trauma. Furthermore, this study found that the orthopaedic trauma patient lost to follow-up is likely to be male, young, a current tobacco user, and uninsured or on a government health insurance plan.