Risk Factors for Poor Follow-up Compliance Among Facial Trauma Patients

Introduction: Facial trauma patients face significant sociodemographic barriers to healthcare; however, there is a paucity of data on follow-up compliance in this population.

Methods: A retrospective, case-control study was performed in the facial trauma clinic of a safety net hospital from October through November 2022. The objective was to determine the rate of missed appointments and identify associated risk factors. Appointment-specific, sociodemographic, trauma, and management data were collected for univariable and multivariable analyses (reported as adjusted odds ratio [aOR], 95% confidence interval [CI]). All analyses were performed on Stata v16.1 (StataCorp, College Station, Texas). Significance was set at p< 0.05.

Results: 156 appointments were scheduled for 108 facial trauma patients (male, 74.1%; African American, 53.7%). Overall, 43 appointments were missed (27.6%). This was associated with initial clinic visits (47.3%) versus subsequent follow-up visits (16.8%; p< 0.001), afternoon visits (42.3%) versus morning (21.8%; p=0.013), uninsured or non-private insurance (34.3%) versus private (13.7%; p=0.007), midface fractures (47.2%) versus mandible (10.5%; p< 0.001), observation (50.0%) versus surgery (18.2%; p< 0.001), and not having external hardware in place, such as arch bars (40.5%) versus having it (12.5%; p< 0.001). There were no significant associations with age, sex, race, or ethnicity (p>0.05 for all tests). After multivariable adjustment, missed appointments remained associated with initial clinic visits (aOR: 2.58, 95% CI: 1.11 – 5.95, p=0.027) and lack of private health insurance (aOR: 2.76, 95% CI: 1.02 – 7.49, p=0.046). In a subgroup analysis of initial clinic visits alone (n=55), missed appointments were negatively associated with mandible fractures (aOR: 0.02, 95% CI: < 0.01 – 0.54, p=0.019) compared to other facial trauma.

Conclusions: Over one-quarter of facial trauma patients missed follow-up appointments, with the greatest risk among initial clinic visits, patients suffering upper third and/or midface trauma, and those without private health insurance.