Laurie's Blogs.


Apr 2022

Non-Adherence to Follow-Up

Laurie Edge-Hughes, BScPT, MAnimSt, CAFCI, CCRT


A recent journal article revealed that adherence to follow-up recommendations was 65.8% for dogs and cats undergoing orthopedic surgery.  What was meant by adherence?  “Cases were considered nonadherent if owners did not return for recommended follow-up visits.”1


Some of the exact results were interesting, but I think they make sense, if we think about them.

  • Elective cases were 1.6 times as likely to be adherent to follow-up recommendations as were urgent cases.
  • Dog cases were 2.4 times as likely to be adherent as were cat cases.
  • Cases with multiple owners listed were 2.1 times as likely to be adherent as were cases with 1 owner listed.


Here’s why I think the findings above make sense.  I think if owners have decided to do a surgery and have purposely thought about setting the money aside to do so, they are then also more motivated to ensure that the case is followed to the end point.  Cats likely hide their pain or sickness more than dogs, so owners might decide that they are better and not bother to follow-up.  Lastly, a two-owner home might have a higher disposable income in order to afford a follow-up visit, have double the ‘man-power’ to be able to get the pet to the follow-up visit, and a little tongue-in-cheek… a double owner household may very well contain a ‘nagging wife’ component (I see this holding true in my household!!!).  


I went to the discussion portion of the paper to see what else could be gleaned from this paper.  When it came to urgent care cases, 58.5% were compliant with follow-up.  Human post-operative orthopaedic surgeries report recheck appointments to be 66.9%.  So, very similar.  


Okay… so what is YOUR adherence rate?  It’s not exactly the same.  Our figures would tend to reflect our fall-off number and discharge numbers.  How many visits does your average patient attend?  What is your fall off after the initial assessment?  Or after initial assessment and 1 follow-up appointment?  How many no-shows do you have in a week?  Where do your referrals come from?  I think these are interesting metrics to follow in your own clinic.


Periodically we have done some stats at our clinic.  Below are charts pertaining to our client retention rates that were drafted a number of years ago.  They looked at client retention for a 90 day period after the initial assessment(s).



What does this tell us?  Well, it was tricky actually, and we didn’t really know what to do with the data.  So we didn’t really do anything with it.  The AVERAGE for client retention from IA to a follow up (for this time span) was 76%.  It dropped to 50% for the 2nd follow up… but to note, the data for the month of May was not followed out for the full 90 days like the previous months had been.


If we wanted to truly know more, we could always do a follow-up survey or phone calls… but there is inherent bias in that as well.  So, all in all, it’s information that makes you go, Hmm…



1.  de Moya KA, Reppenhagen JM, Kim SE. Nonadherence to follow-up recommendations is common for dogs and cats undergoing orthopedic surgery. J Am Vet Med Assoc. 2021 Dec 15;260(S1):S83-S87.