Department of Orthopaedics, West Virginia University, Morgantown, West Virginia.
Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute at Jefferson, Philadelphia, Pennsylvania.
Global Spine J. 2013 Mar;3(1):15-20. doi: 10.1055/s-0033-1337120. Epub 2013 Mar 2.
Long-term outcome studies are frequently hindered by a decreasing frequency of patient follow-up with the treating surgeon over time. Whether this attrition represents a "loss of faith" in their index surgeon or the realities of a geographically mobile society has never been assessed in a population of patients undergoing spinal surgery. The purpose of this article is to determine the frequency with which patients who have undergone prior surgery and develop new problems attempt to follow-up with their index spine surgeon. The study design was a population survey. All patients seen at two university-based spine centers over a 3-month period were surveyed regarding prior spine surgery. The questionnaire asked details of the previous operation, whether the patient had sought follow-up with their index surgeon, why the patient did not continue treatment with that surgeon, and whether the patient was satisfied with their prior treatment. Sixty-nine patients completed the survey. Prior operations were lumbar (53 patients) and cervical (16). When asked the reason for not seeing their prior surgeon, 10 patients (15%) stated that they (the patient) had moved and 16 (23%) responded that their surgeon no longer practiced in the area. Thirteen (19%) were unhappy with their previous care, 22 (32%) were seeking a second opinion, and 7 (10%) were told they needed more complex surgery. Thirty-seven (54%) discussed their symptoms with their original surgeon before seeking another surgeon. Although 32 patients (46%) had not discussed their new complaints with their index surgeon, only 3 patients (4%) chose not to return to their prior surgeon despite having the opportunity to do so. Forty-nine patients (71%) were satisfied with their prior surgical care, and 42 patients (61%) would undergo the index operation again. Most of the patients seen at the authors' practices after undergoing prior spine surgery elsewhere failed to follow up with their prior spine surgeon for geographical reasons. It appears that the majority of patients who develop new spinal complaints will seek out their treating surgeon when possible. This suggests that patient attrition over long-term follow-up may reflect a geographically mobile population rather than patient dissatisfaction with prior treatment.
长期随访研究常常受到患者随时间推移而减少与主治外科医生随访的频率的阻碍。这种流失是对其主治外科医生失去信心，还是反映了地理上流动的社会现实，在接受脊柱手术的患者人群中从未进行过评估。本文的目的是确定先前接受过手术且出现新问题的患者试图与他们的主治脊柱外科医生进行随访的频率。研究设计为人群调查。在三个月的时间里，对在两个大学脊柱中心就诊的所有患者进行了调查，询问他们以前的脊柱手术情况。调查问卷详细询问了之前的手术情况、患者是否寻求过主治外科医生的随访、患者未继续接受该外科医生治疗的原因，以及患者对之前治疗的满意度。69 名患者完成了调查。之前的手术部位为腰椎（53 例）和颈椎（16 例）。当被问及未看他们之前的外科医生的原因时，10 名患者（15%）表示他们（患者）已经搬家，16 名患者（23%）表示他们的外科医生不再在该地区行医。13 名患者（19%）对之前的护理不满意，22 名患者（32%）寻求第二意见，7 名患者（10%）被告知需要更复杂的手术。37 名患者（54%）在寻求其他外科医生之前与他们的主治外科医生讨论了他们的症状。尽管 32 名患者（46%）没有与他们的主治外科医生讨论他们的新投诉，但只有 3 名患者（4%）选择不返回他们的主治外科医生，尽管有机会这样做。49 名患者（71%）对他们之前的手术护理感到满意，42 名患者（61%）会再次接受索引手术。在作者的诊所就诊的大多数患者在其他地方接受过脊柱手术后未能与他们的主治外科医生进行随访，原因是地理位置。似乎大多数出现新脊柱症状的患者在可能的情况下会寻求治疗他们的外科医生。这表明长期随访中的患者流失可能反映了人口的地理流动性，而不是患者对先前治疗的不满。
