Risk Factors for Loss to Follow-Up in the Lower Extremity Limb Salvage Population.

MedStar author(s):
Citation: Plastic & Reconstructive Surgery. 148(4):883-893, 2021 Oct 01.PMID: 34415857Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: MedStar General Surgery Residency | MedStar Georgetown University Hospital | Plastic Surgery Residency | Surgery/Plastic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aftercare/sn [Statistics & Numerical Data] | *Leg Ulcer/su [Surgery] | *Limb Salvage/sn [Statistics & Numerical Data] | *Lost to Follow-Up | Aged | Aged, 80 and over | Amputation/sn [Statistics & Numerical Data] | Chronic Disease/th [Therapy] | Female | Humans | Lower Extremity/su [Surgery] | Male | Middle Aged | Retrospective Studies | Risk Factors | Vulnerable Populations/sn [Statistics & Numerical Data] | Wound HealingYear: 2021ISSN:
  • 0032-1052
Name of journal: Plastic and reconstructive surgeryAbstract: BACKGROUND: Limb salvage for chronic lower extremity wounds requires long-term care best delivered by specialized multidisciplinary centers. This optimizes function, reduces amputation rates, and improves mortality. These centers may be limited to urban/academic settings, making access and appropriate follow-up challenging. Therefore, the authors hypothesize that both system- and patient-related factors put this population at exceedingly high risk for loss to follow-up.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. Copyright (c) 2021 by the American Society of Plastic Surgeons.CONCLUSIONS: This study is the first of its kind to investigate the demographic and clinical characteristics that predispose chronic lower extremity wound patients to loss to follow-up. These findings inform stakeholders of the high rates of loss to follow-up and support decentralized specialty care, in the form of telemedicine, satellite facilities, and/or dedicated case managers. Future work will focus on targeting vulnerable populations through focused interventions to reduce patient and system burden.METHODS: Records were reviewed retrospectively for 200 new patients seen at the Georgetown Center for Wound Healing in 2013. The primary outcome was loss to follow-up, defined as three consecutive missed appointments despite explicit documentation indicating the need for return visits. Demographic, clinical, and geographic data were compared. Multivariate logistic regression analysis for loss to follow-up status controlled for variables found significant in the bivariate analysis. Spatial dependency was evaluated using variograms.RESULTS: Over a 6.5-year-period, 49.5 percent of patients followed were lost to follow-up. Male sex and increased driving distance to the limb salvage center were risk factors for loss to follow-up. Wound-specific characteristics including ankle and knee/thigh location were also associated with higher rates of loss to follow-up. There was no spatial dependency or discrete clustering of at-risk patients.All authors: Abu El Hawa AA, Attinger CE, Deldar R, Evans KK, Fan KL, Sharif-Askary B, Tefera E, Tirrell AR, Zolper EGOriginally published: Plastic & Reconstructive Surgery. 148(4):883-893, 2021 Oct 01.Fiscal year: FY2022Fiscal year of original publication: FY2022Digital Object Identifier: Date added to catalog: 2021-11-01
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Journal Article MedStar Authors Catalog Article 34415857 Available 34415857

BACKGROUND: Limb salvage for chronic lower extremity wounds requires long-term care best delivered by specialized multidisciplinary centers. This optimizes function, reduces amputation rates, and improves mortality. These centers may be limited to urban/academic settings, making access and appropriate follow-up challenging. Therefore, the authors hypothesize that both system- and patient-related factors put this population at exceedingly high risk for loss to follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. Copyright (c) 2021 by the American Society of Plastic Surgeons.

CONCLUSIONS: This study is the first of its kind to investigate the demographic and clinical characteristics that predispose chronic lower extremity wound patients to loss to follow-up. These findings inform stakeholders of the high rates of loss to follow-up and support decentralized specialty care, in the form of telemedicine, satellite facilities, and/or dedicated case managers. Future work will focus on targeting vulnerable populations through focused interventions to reduce patient and system burden.

METHODS: Records were reviewed retrospectively for 200 new patients seen at the Georgetown Center for Wound Healing in 2013. The primary outcome was loss to follow-up, defined as three consecutive missed appointments despite explicit documentation indicating the need for return visits. Demographic, clinical, and geographic data were compared. Multivariate logistic regression analysis for loss to follow-up status controlled for variables found significant in the bivariate analysis. Spatial dependency was evaluated using variograms.

RESULTS: Over a 6.5-year-period, 49.5 percent of patients followed were lost to follow-up. Male sex and increased driving distance to the limb salvage center were risk factors for loss to follow-up. Wound-specific characteristics including ankle and knee/thigh location were also associated with higher rates of loss to follow-up. There was no spatial dependency or discrete clustering of at-risk patients.

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