Socioeconomic status and loss to follow-up after orthopedic trauma surgery

BACKGROUND: Follow-up after surgery is important, to monitor patient recovery and to identify potential complications. Our primary objective was to determine the association between patient socioeconomic status and loss to follow-up after orthopedic trauma surgery. METHODS: We performed a retrospective cohort study of patients aged 18 to 75 years who underwent orthopedic trauma surgery at a trauma centre in Ontario between January 2022 and December 2023. Patient socioeconomic status was determined by linking postal code with Material and Social Deprivation Index and presented as quintiles. We measured clinic follow-up attendance for 6 months after index surgery. We used logistic regression modelling to estimate the association between material deprivation quintiles and loss to follow-up, accounting for baseline patients and perioperative factors. RESULTS: The study cohort included 1764 patients. Approximately 1 in 4 patients missed at least 1 follow-up appointment in the 6 months after surgery. Odds of missed follow-up with no return were 83% higher in patients in the most deprived quintile, compared with patients who were least deprived (odds ratio 1.83, 95% confidence interval 1.09 to 3.08). Younger age and higher American Society of Anesthesiologists Physical Status score were associated with increased odds of loss to follow-up. Geographic distance to hospital was not independently associated with loss to follow-up. CONCLUSION: Loss to follow-up is common after orthopedic trauma surgery, and the risk is higher in patients who are most socioeconomically disadvantaged. Innovative solutions should address the needs of specific patient groups to optimize patient access to appropriate, timely follow-up after orthopedic trauma surgery.