A quality improvement study to reduce 'Lost to Follow-Up' patients in surgical site infection surveillance

Effective surgical site infections (SSIs) surveillance improves patient outcomes and ensuring evidence-based prevention strategies. However, data generated by surveillance programs is hindered by data of patients lost to follow-up (LTFU), which introduces bias.

This study was conducted to evaluate and reduce LTFU rates among lower-segment cesarean section (LSCS) patients enrolled in SSI surveillance.

This prospective observational study analyzed 5057 LSCS surgeries (962 elective and 4095 emergent) from February 2021 to December 2021 (baseline phase) and December 2022 to September 2024 (intervention phase). Women who underwent LSCS procedures were enrolled in an SSI surveillance program, with follow-up data collected through structured protocols. Targeted interventions, including enhanced communication methods, expanded contact information collection, and patient engagement, were implemented to address identified barriers. Chi-square tests and regression was assessed between the occurrence of LTFUs, demographics, and procedure types.

LTFU rate in the baseline phase was 10.9% (125/1152), with key reasons including incorrect data (0.88%), network/issues (1.4%), non-communicative behavior of patients (1.2%) and patient related logistics (0.5%) (e.g. poverty). After interventions, the LTFU rate decreased to 2.2% (85/3905) in the intervention phase (P < 0.05, OR = 5.470, 95% CI 4.117-7.267).

This study highlights the multifactorial nature of LTFU during SSI surveillance, influenced by individual, systemic and environmental factors. Targeted interventions, such as improved communication strategies, tailored patient engagement, leveraging technology and robust data collection protocols, significantly enhanced follow-up rates. These findings provide actionable insights to optimize SSI surveillance and mitigate LTFU-related challenges in healthcare settings.