Is follow up by specialists routinely needed after elective surgery? A controlled trial

Abstract

Study objective: To assess the benefit of planned specialist follow up appointments after elective inpatient surgery.

Design: This was a controlled trial, using repeated alternate allocation of time periods to the two study groups. Group 1: Planned outpatient follow up 6-12 weeks after surgery. Group 2: No planned follow up: additional written information for patients and general practitioners.

Setting: A district general hospital in the north west of England.

Participants: 264 patients listed for one of: transurethral resection of the prostate, varicose vein surgery, cholecystectomy (open or laparoscopic), inguinal herniorraphy (open or laparoscopic).

Main outcome measures: Health status, complications, return to normal activity, patient satisfaction, use and costs of primary and secondary care in the 12 weeks after surgery.

Main results: Data were available for 212 (80%) of eligible patients. Thirty eight per cent of patients in the "no planned follow up" group were in fact seen in outpatients after their discharge. Intention to treat analysis showed that there were no significant differences between the groups for health status, complications, or time to return to normal activity. Patients in the "no planned follow up" group had significantly fewer hospital visits and costs (mean difference in visits 0.51, 95% confidence intervals 0.39 to 0.69; mean difference in hospital costs 12.75 Pounds, 9.75 Pounds to 15.50 Pounds). There were fewer primary care staff contacts and costs in the "no planned follow up" group, although this difference was not significant (mean difference = 0.61 visits, -0.13 to 1.33 visits; primary care costs difference 8.37 Pounds, -1.31 Pounds to 18.73 Pounds). Patients in the "no planned follow up group" had significantly reduced patient travel costs (mean difference 4.84 Pounds, 3.44 Pounds to 6.22 Pounds). Eighty nine (42%) patients would prefer to be followed up by both their hospital doctor and GP; 53 (25%) patients would prefer to be followed up by the hospital doctor only. There were no significant differences between the two groups in their preferences for follow up. The majority of GPs agreed with the statement that a policy of no follow up at hospital outpatients for each of the six surgical procedures would increase their workload.

Conclusions: Planned outpatient appointments after uncomplicated surgery seem to be neither necessary nor cost effective. A policy of "no planned follow up" results in no increase in primary care costs, and savings in hospital and patient costs. However, many patients expected and wanted to be seen again by their surgeon and GPs were concerned that a "no follow up" policy would result in an increase in workload.