Ensuring Ongoing Care for Orthopedic Patients

Each year, hundreds of orthopaedic surgeons travel to developing countries to treat and care for patients. Yet despite the successful completion of many surgical procedures on patients who may not otherwise have access to care, adequate follow-up—so critical to optimal outcomes—is not always available or guaranteed.
 
A new study appearing in the Journal of Bone and Joint Surgery found that a sustainable surgical follow-up program may not only be possible, but cost-effective in ensuring acceptable outcomes, even in an austere environment.
 
Between July 2007 and January 2012, 10 surgical mission trips were completed in Peru with a mean time of six days on location, and a mean number of 2.3 surgeons (between two and five surgeons) per trip. A Peruvian general surgeon, paid by the surgical mission group, oversaw postoperative visits at time intervals of two to four weeks, five to 16 weeks, four to seven months, and eight to 12 months after surgery.
 
Each follow-up visit included the completion of a patient outcome form; radiographs; functional range-of-motion photographs; and assessment of demographics, the type of surgical procedure, complications—infection, malunion or nonunion (whether or not a bone adequately healed)—and clinical results.
 
Of the 127 patients eligible for follow-up, 81.9 percent (104) were seen for post-surgical care. The mean length of follow-up was 11.8 months, with a mean number of 3.7 postoperative encounters.

Orthopedic trauma fixation (the setting and surgical repair of broken bones) was the most common procedure (57 percent) with 42 of them (40 percent) requiring surgery (open reduction and internal fixation). Of the 104 patients, 101 (97 percent) experienced successful wound healing, and 100 (96 percent) had a functional outcome deemed to be fair or good by a local physician. Ninety-seven percent of the fractures were successfully repaired.

The infection rate was 2.9 percent (three patients) with 97 percent of the fractures adequately healed and united, according to the study, which is still underway. The mean direct cost of the follow-up program was $20,041 in U.S. dollars per year.
 
“This model puts the incentive for follow-up on the designated local medical provider and also provides the visiting surgeons with necessary post-trip follow-up results up to 1 year later,” said Peter A. Cole, M.D., orthopedic surgeon and professor of orthopedics at the University of Minnesota and lead study author. “It is a fundamentally new way of thinking about successfully collecting follow-up information from patients. Other than in certain disaster-relief situations, it is possible for surgical missions to the developing world to implement programs which track the outcomes of their intervention. Following the outcome of your surgery can be as important as closing the wound.”