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The efficacy of postoperative visits for detecting complications in pediatric patients
Alyssa Stetson1, Tommy Kim1, Raissa Li1
1Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA.
Insights
Scheduled follow-up visits after pediatric surgery do not reliably detect complications. Shifting to an "as needed" follow-up approach may improve surgeon access for new patients needing care.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Patient Outcomes
Background:
- Long wait times for new patients delay care and reduce satisfaction.
- Minimizing nonessential follow-up visits could increase surgeon availability.
- Postoperative visits aim to detect complications, but data on detection methods is limited.
Purpose of the Study:
- To examine if scheduled follow-up visits effectively detect complications after low-risk pediatric procedures.
- To assess the impact of scheduled follow-up visit rates on the detection of postoperative complications.
Main Methods:
- A single-center observational study analyzed data from 2,676 children undergoing appendectomy, hernia repair, pyloromyotomy, or circumcision (2016-2023).
- Utilized Current Procedural Terminology/International Classification of Diseases codes and chart review.
- Defined "uncaptured complications" as those diagnosed outside of scheduled follow-up visits.
Main Results:
- The median rate of uncaptured complications was 1.4% regardless of the surgeon's scheduled follow-up visit rate (low vs. high).
- Higher scheduled follow-up visit rates did not significantly reduce the incidence of uncaptured complications.
- Procedure type and younger patient age were the primary predictors of uncaptured complications.
Conclusions:
- Routine scheduled follow-up visits are not an effective method for capturing postoperative complications in healthy children after low-risk operations.
- Adopting an "as needed" follow-up model could enhance surgeon availability for new patient consultations.
Background:
Long wait times for new patient visits can delay necessary care and lead to patient dissatisfaction. Minimizing nonessential scheduled follow-up visits may increase surgeons' availability to see new patients. Postoperative clinic visits are typically scheduled to detect complications. However, there is limited data on how often postoperative complications are diagnosed during scheduled follow-up visits versus during other encounters. We examined whether complications were routinely detected during scheduled follow-up visits after low-risk procedures in healthy children.
Methods:
A single-center observational study was performed using Current Procedural Terminology/International Classification of Diseases codes and a chart review. Our cohort included patients who underwent appendectomy, inguinal hernia repair, pyloromyotomy, or circumcision between 2016 and 2023. A scheduled follow-up visit was defined as a postoperative clinic visit with a surgeon that was made ≥3 days before the clinic visit date and within 8 weeks of surgery. A complication that was diagnosed at an encounter other than the scheduled follow-up visit was defined as an "uncaptured complication." The primary exposure was provider scheduled follow-up visit rate, and the primary outcome was rate of uncaptured complications.
Results:
In total, 2,676 patients were included. Surgeon scheduled follow-up visit rate was categorized as low versus high based on the mean scheduled follow-up visit rate of 63%. The median rate of uncaptured complications for physicians with both a low scheduled follow-up visit rate and a high scheduled follow-up visit was 1.4% (P = .99). Even on adjusted analysis, high scheduled follow-up visit rate was not protective against uncaptured complications. Only procedure type and younger age were predictive of incidence of uncaptured complications.
Conclusion:
Routine scheduled follow-up visits after low-risk operations in healthy children do not effectively capture postoperative complications. Implementing a culture of follow-up as needed could increase surgeon availability to see new patients in ambulatory clinics.
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