Predictors of loss to follow up among patients with open tibia shaft fracture treated at Muhimbili Orthopedic Institute: Aretrospective cohort study

Abstract

ABSTRACT Background: Loss to follow up (LFTU) of postoperative patients in orthopedic clinics is a common problem and brings challenges to management of patient and planning for career developments of attending Surgeons and Hospital. Geographic, socioeconomic and clinical factors may impede follow-up after lower extremity trauma. We sought to identify barriers that may predict loss to follow-up in orthopedics for patients with open tibia shaft fracture after treatment. Objective: To evaluate the incidence and reasons for patient’s loss to follow up after six months post operative treatment of open tibia shaft fractures at MOI Dar Es Salaam between January 2016 and June 2017. Methods: A retrospective cohort hospital based study was carried out on patients who were treated for open tibia shaft fracture between January 2016 and June 2017. The study was conducted between August 2018 and February 2019 to ascertain predictors of LFTU six months and later clinics. Data were obtained from hospital records and through structured questionnaires administered by phone call to study participants. Extra questions were asked to lost patients to ascertain reasons for attrition. Results: In this study there were 253 participants, 188(74.3%) completed clinic follow up with 65 (25.7%) LFTU. Among the participants 219 (86.6%) were males and 34 (13.4%) were females with mean age of 32.4 years (SD 10.7). Logistic regression showed that having none to primary level of education (p <0.001), living more than 100km from hospital (p = 0.005) and depending on relatives for hospital bills payment (p = 0.016) were significantly associated with LTFU. Among 65 loss to follow up 43.1% stated attrition was due to shifting to another region after injury or living far from the hospital, 33.8% lack of money for transport, 16.9% felt good and healed and said there was no reason to continue attending the clinic, 27.7% forgot and travelled during the follow up and didn’t reschedule the appointment, 10.7% were unsatisfied with treatment offered to them and attended other hospitals. Conclusions: LFTU among patients with open tibia shaft fractures treated at MOI is a problem among young uneducated patient with predisposing factors being socio-demographic and economical. Recommendation: Addressing LTFU and maximizing clinic attendance of patients. This can be through; establishing a follow up program in the hospital, calling patients days before and educating patients on the importance of follow up.