Optimizing postoperative follow-up in pediatric surgery (OFIPS)

Abstract

Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.