title: What factors influence follow-up in orthopedic trauma surgery?
abstract: BACKGROUND
  Among surgical patients, follow-up visits are essential for monitoring post-operative recovery and determining ongoing treatment plans. Non-adherence to clinic follow-up appointments has been associated with poorer outcomes in many different patient populations. We sought to identify factors associated with non-attendance at follow-up appointments for orthopedic trauma patients.
  
  
  METHODS
  A retrospective chart review at a level I trauma center identified 2,165 patients who underwent orthopedic trauma surgery from 2008 to 2009. Demographic data including age, sex, race, tobacco use, American Society of Anesthesiologist (ASA) score, insurance status, distance from the hospital, and follow-up time were collected. Injury characteristics including fracture type, anatomic location of the operation, length of hospital stay, living situation and employment status were recorded. Attendance at the first scheduled follow-up visit was recorded. Multivariable log-binomial regression analyses were used with statistical significance maintained at p < 0.05.
  
  
  RESULTS
  Of the 2,165 patients included in the analysis, 1,449 (66.9 %) attended their first scheduled post-operative clinic visit. 33.1 % (717) were not compliant with keeping their first clinic appointment after surgery. Patients who used tobacco, lived more than 100 miles from the clinic site, did not have private insurance, had an ASA score >2, or had a fracture of the hip or pelvis were significantly less likely to follow-up. Age, sex, and race were not significantly associated with failure to follow-up.
  
  
  CONCLUSIONS
  Follow-up appointments are essential for preventing complications among orthopedic trauma patients. By identifying patients at risk of failure to follow-up, orthopedic surgeons can appropriately design and implement long-term treatment plans specifically targeted for high-risk patients.
authors.affiliation: Department of Orthopedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Whiting
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Greenberg
authors.forename: Rachel V
authors.initials: RV
authors.lastname: Thakore
authors.forename: Vignesh K
authors.initials: VK
authors.lastname: Alamanda
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.forename: Alex
authors.initials: A
authors.lastname: Jahangir
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000293:injuries* / Q000601:surgery; D009819:Office Visits / Q000706:statistics & numerical data*; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013714:Tennessee / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data