Long-Term Patient Follow-up: Not Easy but Worth the Effort
Longer-term follow-up of orthopaedic patients is instrumental to research and the advancement of patient care. One simply cannot understand the impact of surgical decision-making and technique without examining the patient, assessing images, and evaluating function over time. However, in all areas of orthopaedic surgery, we struggle to get patients to return for evaluation when they feel mostly recovered. If patients are doing well in terms of pain and function, they may understandably see little or no clinical imperative to return for follow-up. This is particularly true among younger, more active patients—the primary group involved in higher-energy trauma and those who are perhaps the most resistant to follow-up visits.
Conversely, the orthopaedic research community and the journals that publish their findings have a widely embraced expectation of 1-year minimum follow-up. Agel et al. closely scrutinize this expectation/reality disconnect in a recent JBJS report. Reviewing 293 patients treated surgically for acute orthopaedic trauma injuries (mean age, 47.5 years), the authors observed a 29% rate of 1-year follow-up. Evaluating potential risk factors for patients not following up, they identified tobacco use, final appointment status (follow-up as needed vs request to return), isolated vs. multiple fractures, and distance from the trauma center as significant predictors.
While the authors ultimately concluded that a 1-year follow-up requirement “may not be feasible,” I think treating physicians can play a critical role in improving follow-up, even in trauma cases, where a physician-patient relationship may not exist prior to treatment. In addition to cementing a relationship with all our patients, we should clearly articulate that returning for evaluation will help subsequent patients with similar injuries or conditions.
In their “Author Insights” video about this study, co-authors Conor P. Kleweno, MD and Avrey A. Novak, MD cite new technologies for contacting patients for follow-up evaluations. I believe that, given convenient opportunities to do so, many patients will want to help us improve care for those who come after them.
Marc Swiontkowski, MD