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

Introduction Postoperative follow-up after open reduction and internal fixation (ORIF) of distal radius fracture varies widely, yet determinants of follow-up utilization are poorly understood. The purpose of this study was to evaluate the independent influence of surgeon-level factors versus patient sociodemographics on follow-up utilization. We hypothesized that, in a modern integrated health system, surgeon-specific practice infrastructure would be the primary driver of variability in follow-up. Methods This retrospective cohort study (2019-2024) analyzed adult distal radius ORIF patients within a single health system. Multivariable negative binomial regression evaluated patient demographics, comorbidities, insurance, and operating surgeon as predictors of postoperative follow-up frequency. Secondary outcomes included complications, including nerve, tendon, wound-related issues, and hardware removal. Surgeon identities were de-identified, with low-volume providers grouped as "Other". Results Among 731 patients (mean age: 55.3 years), the mean surgeon follow-up was 1.95±1.79 visits (range: 0-11). While 190 (26%) patients had zero encounters with the operating surgeon, all 731 (100%) patients received clinical surveillance via advanced practice providers (APPs). Multivariable regression identified female sex (incidence rate ratio (IRR): 1.26; 95% CI: 1.08-1.46; z=2.997; p=0.003) and private insurance (IRR: 1.31; 95% CI: 1.06-1.63; z=2.494; p=0.013) as independent predictors of higher utilization. Surgeon identity was the strongest predictor of follow-up frequency, with significant variation across providers (p<0.05). Although complications occurred in only 53 patients (7.3%), they were strongly associated with increased visits (IRR: 2.47; 95% CI: 2.14-2.85; z=12.37; p<0.001); however, complication rates did not fully account for the observed provider-level variability. Age, race, comorbidities, and smoking status were not significant predictors (p>0.05). Conclusion Postoperative follow-up utilization after distal radius ORIF demonstrates marked variability and is influenced by both patient- and provider-level factors. Surgeon-specific practice patterns play a substantial role in determining follow-up frequency.