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Predictors of Loss to Long-Term Follow-up After Shoulder Surgery
Silvia Soule1, Alec Smith1, Tyler Staten1
1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
The Journal of Bone and Joint Surgery. American Volume
|June 16, 2026
Summary
Older patients are more likely to complete 2-year follow-up after shoulder surgery. Younger patients, especially those undergoing instability surgery, are at higher risk for loss to follow-up, necessitating targeted interventions.
Area of Science:
- Orthopedic surgery outcomes research
- Clinical trial methodology and bias reduction
Background:
- Loss to follow-up is a significant source of bias in clinical research.
- Identifying factors influencing patient adherence to 2-year follow-up after shoulder surgery is crucial for data integrity.
Purpose of the Study:
- To identify demographic and clinical factors associated with failure to complete a 2-year follow-up after shoulder surgery.
- To test the hypothesis that older patients have higher follow-up rates and instability surgery patients have lower rates.
Main Methods:
- Retrospective chart review of 1,028 shoulder surgery patients (2017-2022).
- Contact via phone, text, and email at 2 years postoperatively.
- Multivariable logistic regression analyzing age, insurance, procedure type, Social Deprivation Index (SDI), and distance.
Main Results:
- 49% of patients completed 2-year follow-up; older patients (mean age 53 vs 49) were more likely to adhere.
- Loss to follow-up associated with instability surgery, Medicaid/Workers' Compensation insurance, and missing pain scores.
- Younger age (OR, 0.99) and missing VAS scores (OR, 1.51) independently predicted loss to follow-up; current alcohol use (OR, 0.74) was protective.
Conclusions:
- Older age is the strongest predictor of follow-up adherence in shoulder surgery patients.
- Targeted strategies are needed to improve follow-up rates in younger patients, those undergoing instability surgery, and those with specific insurance types.
