title: Factors Associated with Patient-Initiated Telephone Calls After Spine Surgery.
abstract: BACKGROUND
  Telephone calls play a significant role in the follow-up care of postoperative patients. However, further data are needed to identify the determinants of patient-initiated telephone calls after surgery because these factors may also highlight potential areas of improvement in patient satisfaction and during the hospital discharge process. Therefore, the goal of this study is to determine the number of postoperative patient telephone calls within 14 days after surgery and establish the factors associated with patient-initiated calls and reasons for calling.
  
  
  METHODS
  A retrospective chart review of all spine surgeries performed at our institution from January 1, 2014, through January 2, 2015, was completed. Patient demographics, perioperative and operative variables, and telephone encounter data were collected. The primary outcome was a patient-initiated telephone call within 14 days after surgery. Secondary outcomes included reporting and analyzing the reasons for patient phone calls, analyzing which procedures were associated with the most telephone calls, and conducting a multivariate analysis to determine independent risk factors for patient calls.
  
  
  RESULTS
  Of the 488 patients who underwent surgical procedures, 222 patients (45.7%) made a telephone call within 14 days after surgery. There were 61 patients (27.48%) who called regarding pain control and 54 patients (23.87%) who called with bathing/dressing/wound questions. Other common categories include the following: other (21.17%), medication problems (15.77%), weight-bearing status/activity restrictions (5.14%), fever (3.15%), bowel management (1.35%), work notes (1.35%), and anticoagulation questions (0.45%). Factors associated with a telephone call within 14 days postoperatively included increased body mass index (P = 0.031), lower number of comorbidities (P = 0.043), telephone call within 2 weeks prior to surgery (P = 0.027), American Society of Anesthesiologists (ASA) score of 2 (P = 0.036), discharge disposition to home (P = 0.003), and elective procedure (P = 0.006). Multivariate analysis revealed that fusion procedures (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.05-4.45; P = 0.037) and ASA score of 3-4 (OR, 0.55; 95% CI, 0.31-0.96, P = 0.036) were independently associated with increased and decreased propensity, respectively, toward making a phone call within 2 weeks.
  
  
  CONCLUSIONS
  Postoperative patient-initiated telephone calls within 14 days after spine surgery are very common, occurring after almost one half of all procedures. By evaluating such determinants, patient care can be improved by better addressing patient needs during and prior to discharge to prevent potential unnecessary postoperative calls and improve patient satisfaction.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Risa
authors.initials: R
authors.lastname: Reid
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Puvanesarajah
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Kandil
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Baris
authors.initials: B
authors.lastname: Yildirim
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Shimer
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Anuj
authors.initials: A
authors.lastname: Singla
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Francis H
authors.initials: FH
authors.lastname: Shen
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: hh4xd@hscmail.mcc.virginia.edu.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013689:Telephone / Q000706:statistics & numerical data*
keywords: Patient satisfaction; Spinal surgery; Telephone calls