Routine surgical follow up: do surgeons agree?BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7016.1344 (Published 18 November 1995) Cite this as: BMJ 1995;311:1344
- Alison Waghorn, surgical research registrara,
- Jeremy Thompson, senior lecturer in surgeryb,
- Martin McKee, reader in public health medicinea
- aHealth Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
- bRoyal Postgraduate Medical School, Hammersmith Hospital, London W12 0NN
- Correspondence to: Ms Waghorn.
- Accepted 8 September 1995
The move to primary care led purchasing in the NHS1 is focusing attention on the role of outpatient review, especially for postoperative patients. General practitioners have questioned whether such routine reviews could be reduced, describing them as of limited clinical value and a waste of patients' time.2 Some surgeons agree, noting that most patients' postoperative problems are identified by general practitioners before their appointment.3 The limited evidence available suggests that there are indeed opportunities for change. A randomised controlled trial comparing postoperative follow up in outpatient clinics and general practice found no difference in readmission rates or mortality, and patients were equally satisfied with either method.4 The general practice option was, however, cheaper for both the patient and the health service and resulted in a minimal increase in general practitioner workload.
Despite this apparent consensus in published reports, a major shift to primary care does not seem to have occurred and the advocates of change may be unrepresentative of their colleagues. We therefore surveyed a sample of British consultant surgeons on their views about routine postoperative follow up for common surgical conditions.
Subjects, methods, and results
A questionnaire was sent to 100 consultant surgeons selected at random from a database containing details of all consultant general surgeons employed in the NHS (CAM Data Services). Twelve of the most common routine surgical operations were selected and respondents were invited to indicate the percentage of patients that they would normally offer an outpatient follow up appointment to. For those patients who were seen postoperatively we also asked the length of the follow up period and the number of times the patients would be seen within this period. Following a reminder, the response rate was 75%. Of the 75 respondents, 18 were from teaching and 57 from district general hospitals. Responders did not differ from non-responders in either type of hospital (χ2=0.75, 1 df, P=0.38) or years since qualification (Mann-Whitney U test, z=1.4547, P=0.146). When follow up was described as indefinite a figure of 20 years was assumed for statistical analysis.
The results are shown in the table. These show widespread variation in the extent to which surgeons normally offer follow up appointments for many common conditions. For most procedures the distribution of responses was bimodal, with some surgeons offering appointments to all patients and others to none. For some of the commonest procedures, such as inguinal hernia repair, the numbers of surgeons advocating follow up or discharge were evenly split. Once the decision to offer an appointment had been made there was less variation in the proposed length of follow up and number of visits. There was no significant difference in the percentage of patients followed up for any procedure between teaching and district general hospital consultants. In comments on the questionnaires some surgeons said they thought issues such as the threat of litigation and patient satisfaction influenced their decisions.
Florey et al suggested that some postoperative follow up presently conducted in hospitals could be transferred to primary care and that such a move was supported by some surgeons.4 Indeed, others have questioned the value of routine follow up even in some cases where there was unanimity among our sample.5 6 If such a change is to occur, however, we need a better understanding of the reasons why different surgeons take such divergent views and whether their perceptions coincide with those of patients and general practitioners. These topics are the subjects of a follow up study.
Funding NHS research and development programme in the primary-secondary interface.
Conflict of interest None.