Home care visits: The key to reducing loss to follow-up in emergency colorectal surgery

Abstract

Background

Emergency colorectal surgery has a high incidence of postdischarge complications, and loss to follow-up can delay the identification of complications. Amid evolving postdischarge care practices, it is important to assess predictors of loss to follow-up. We aimed to characterize the predictors of loss to follow-up.

Methods

We conducted a retrospective institutional cohort study of patients ≥18 years undergoing emergency colorectal surgery at a tertiary hospital from 2016 to 2022. We excluded patients with in-hospital or 30-day mortality or a postoperative stay >30 days. We defined loss to follow-up as the absence of a postdischarge 30-day in-person or telehealth visit. The predictors of loss to follow-up were evaluated using stepwise regression analysis. We performed a subgroup analysis evaluating predictors of loss to follow-up among patients discharged post-telehealth availability at our institution (March 2020).

Results

We included 426 patients, of whom 95 (22.3%) were loss to follow-up and 58.9% were discharged post-telehealth availability. Almost one half of patients were female (52.3%), and the majority were of White race (89.2%), and non-Hispanic (92.0%). Being male, being discharged to a skilled nursing facility, and prolonged hospitalization were risk factors for loss to follow-up, whereas receiving home care visits was protective. Post-telehealth availability, being male, and prolonged hospitalization were risk factors for loss to follow-up, whereas receiving homecare visits was protective. Patients who had a follow-up visit were less likely to be readmitted to the hospital and have a visit to the emergency department.

Conclusion

Receiving home care visits was the most protective factor for preventing loss to follow-up. Living far from the hospital remained a risk factor even post-telehealth availability. High-risk patients may benefit from targeted interventions that include scheduled home care visits.