Factors leading to loss to follow-up after strabismus surgery in children

Abstract

To assess risk factors for loss to follow-up (LTFU) and identify obstacles to follow-up care in these patients. The medical records of all children (<18years old) who underwent strabismus surgery over a 6-year period at a single institution were reviewed retrospectively. Patients were considered LTFU if they failed to attend a follow-up appointment between 3weeks and 6months postoperatively. Variables collected for all patients included age, sex, race/ethnicity, and insurance type. A telephone survey of parents/guardians of all patients LTFU was conducted to determine potential barriers to follow-up care. Demographic information was compared between those not LTFU and those LTFU as well as those LTFU and those LTFU who completed the survey. Reasons for LTFU were quantified and classified by category. Patients LTFU were significantly more likely to be black than white or Asian and have state or government-based insurance rather than private or employer-based insurance. The most common reasons cited for not following-up included perceived positive outcome (47%), work conflicts (37%), transportation issues (30%), travel time (30%), and having forgotten (27%). Patients were LTFU because parents or guardians perceived follow-up as unnecessary, were faced with scheduling or transportation impediments, or simply forgot to appear. Possible remedies include increasing education through teach-back, offering telemedicine appointments, and sending multiple appointment reminders.