Analysis of clinical characteristics and influencing factors of outpatient follow-up visits in patients after lumbar fusion surgery

English Keywords:Lumbar fusion surgery  Outpatient follow-up  Influencing factors

English Abstract:

  【Abstract】 Objectives: To explore the clinical characteristics and influencing factors of outpatient follow-up visits for patients after lumbar fusion surgery. Methods: A retrospective analysis was conducted on the case data of patients who underwent lumbar fusion surgery due to lumbar degenerative diseases at our hospital from January 2019 to December 2023. All patients were educated upon discharge and were instructed to return to the hospital for follow-up visits at 1 month, 3 months, 6 months and 12 months after operation, and to have a follow-up visit once a year thereafter. The general clinical data, surgery-related data, length of hospital stay and outpatient follow-up time of the patients were collected. The patients were grouped according to whether they returned to the hospital for follow-up after operation. Univariate logistic regression analysis was conducted first to observe the correlations between gender, age, residential area, expense category, disease type, length of hospital stay, hospitalization expense, surgical approach, postoperative complications, ADL score at discharge and return to the hospital for follow-up visit. Multivariate logistic regression analysis was conducted on the influencing factors of non-follow-up visit after surgery for variables with P<0.2. Further, the follow-up patients were divided into a long-term follow-up group(follow-up time≥12 months) and a short-term follow-up group(follow-up time<12 months), and subgroup analyses were conducted on the follow-up conditions of patients at each time point and whether they were long-term follow-up. Results: A total of 5,520 patients underwent lumbar fusion surgery due to lumbar degenerative diseases. Among them, 4,198 patients returned to the hospital for follow-up after operation, with a follow-up rate of 76.1%. Among them, 1,213 patients had a follow-up time of ≥12 months, accounting for 22.0%. Multivariate logistic regression analysis indicated that male, older age, and long hospital stay were the hindering factors for postoperative follow-up visits. Employee medical insurance, having a bachelor′s degree or above, lumbar spinal stenosis and lumbar spondylolisthesis, and anterior surgery were the promoting factors for postoperative follow-up visits. In the subgroup analysis, multivariate logistic regression showed that male and older patients at each time point were hindering factors for follow-up visits, while employee medical insurance was a promoting factor for follow-up visits. In terms of disease types, lumbar spinal stenosis was a promoting factor for follow-up visits at 1 month and 6 months after operation, and lumbar spondylolisthesis and discogenic low back pain were promoting factors for follow-up visits at 6 months after operation. In terms of educational level, having a bachelor′s degree or above was a promoting factor for follow-up visits at 12 months after operation and for long-term follow-up visits. In the surgery approach analysis, anterior surgery was a hindering factor for follow-up visits at 1 month after operation, but became a promoting factor for follow-up visits at 12 months after operation. Additionally, long hospital stay was a hindering factor for follow-up visits at 1 month after operation, living in the city was a hindering factor for follow-up visits at 12 months after operation, and high hospitalization costs were a promoting factor for long-term follow-up visits. Conclusions: Male and older age are barriers to outpatient follow-up at all postoperative time points, while employee medical insurance is a facilitating factor. Targeted follow-up strategies should be developed based on the characteristics of outpatient visits at different stages for patients.