An Update on Loss to Follow-up After Upper Extremity Surgery: Survey of Patient Responses

Abstract

Background: Incomplete patient follow-up is a common problem after hand and upper extremity (HUE) surgery and is influenced by many demographic factors. The aims of this investigation are to determine patient-stated factors for lack of follow-up, identify potential interventions, and measure satisfaction following operations. Methods: A prospective survey sampling of 173 of 655 patients lost to follow-up after HUE operations in a single institution between June 2014 and July 2015 was performed. Demographic variables collected included age, sex, distance to clinic, insurance payor, and length of time to last follow-up visit. Survey responses regarding reasons for insufficient follow-up, future recommendations, and overall satisfaction were recorded. Statistical results were reported as P values, odds ratios (ORs), and 95% confidence intervals (CIs). Results: More than half (65.3%) of 173 patients erroneously thought that they had completed follow-up, with private insurance being the only risk factor (OR = 2.45, P = .010, 95% CI = 1.24-4.85). Other common reasons for insufficient follow-up included not placing the appointment into a personal calendar (7%), excessive costs (6%), and transportation (5%). Approximately half (51%) of 55 patients aware that they had missed follow-up stated that no intervention would have helped. Median patient satisfaction with their operation was 10/10 (interquartile range = 8-10). Conclusions: Most patients lost to follow-up after HUE operations were not aware that they had a follow-up appointment, but were nevertheless satisfied with treatment. Interventions targeted to patients who erroneously thought they had followed up may be the most beneficial.

Keywords: follow-up; patient satisfaction; survey; upper extremity surgery.

Figure 1.

Reasons stated by patients why they were lost to follow-up, with 173 patients agreeing to answer the associated question. Percentages represent the proportion of patients in each category.

Figure 2.

Recommendations that would have improved follow-up provided by the subset of patients who were aware that they did not complete all recommended follow-up and agreed to answer the associated question, comprising a total of 55 patients. Percentages represent the proportion of patients in each category.