title: Compliance with recommendations for tympanostomy tube follow-up: patient characteristics.
abstract: OBJECTIVE
  (1) To determine the percentage of otherwise healthy patients achieving "graduation," or postoperative compliance achieving complete problem resolution and discharge from the otolaryngologist's care, after tympanostomy tube placement. (2) To analyze follow-up behaviors and patient characteristics influencing the likelihood of graduation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Analysis of details of tympanostomy tube placements performed from 2004 to 2011 by 2 pediatric otolaryngologists for children aged 0 to 18 years. Exclusion criteria were clearly defined craniofacial anomalies, cleft palates, and other ongoing postoperative care. The remaining study subjects were categorized into 3 groups. Graduation (GRAD) subjects achieved discharge from care with "follow-up pro re nata" status. LOST<2Y subjects had not attended scheduled follow-up in <2 years. LOST≥2Y subjects had no follow-up in ≥2 years.
  
  
  RESULTS
  A total of 1454 pediatric subjects were included. GRADs constituted only 25.6% of the subject pool; 22.1% were LOST<2Y, and 52.3% were LOST≥2Y. Statistically significant factors in achieving graduation were total number of follow-up visits, total duration of follow-up, compliance with first postoperative visit, patient age, insurance type, and distance between home and practice.
  
  
  CONCLUSIONS
  Rate of graduation, or postoperative compliance achieving complete problem resolution, of otherwise healthy tympanostomy tube patients is low despite perioperative discussions of the importance of proper follow-up. Higher graduation rates are associated with increasing number of follow-up visits and duration, younger patient age, private insurance, and proximity to the practice. Compliance with attending the first postoperative visit may be an early marker for increased likelihood of graduation.
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Kao
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kirse
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina, USA akevans@wakehealth.edu.
authors.forename: Adele K
authors.initials: AK
authors.lastname: Evans
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000592:standards* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects / Q000379:methods*; D008991:Monitoring, Physiologic / Q000592:standards / Q000639:trends; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000592:standards / Q000639:trends; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: otitis media; pediatric compliance; postoperative care; tympanostomy tube