Factors Producing Variation in Postoperative Surveillance After Distal Radius Open Reduction and Internal Fixation: A...

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Patient Outcomes

Background:

• Postoperative follow-up protocols for open reduction and internal fixation (ORIF) of distal radius fractures lack standardization.
• Understanding the factors driving variations in follow-up care is crucial for optimizing patient management.

Purpose of the Study:

• To investigate the independent contributions of surgeon-level factors and patient sociodemographics to postoperative follow-up utilization.
• To test the hypothesis that surgeon-specific practice infrastructure is the primary determinant of follow-up variability in an integrated health system.

Main Methods:

• Retrospective cohort study of adult distal radius ORIF patients (2019-2024) within a single health system.
• Multivariable negative binomial regression analysis to identify predictors of follow-up frequency.
• Inclusion of patient demographics, comorbidities, insurance, and operating surgeon as variables; secondary outcomes included complications.

Main Results:

• Mean follow-up was 1.95 visits, with 26% of patients having no direct surgeon encounters but all receiving care from advanced practice providers (APPs).
• Female sex and private insurance were associated with higher follow-up utilization (p<0.05).
• Surgeon identity was the strongest predictor of follow-up frequency, demonstrating significant provider-level variation (p<0.05). Complications increased visits but did not explain provider variability.

Conclusions:

• Postoperative follow-up utilization after distal radius ORIF is highly variable, influenced by both patient and provider factors.
• Surgeon-specific practice patterns significantly impact the frequency of postoperative follow-up.
• Further research into standardizing follow-up care based on evidence is warranted.