SynthesisBJS open2026
Patient-initiated follow-up in surgical specialties: meta-analysis and meta-regression.
Synthesis in BJS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRising outpatient demand has accelerated adoption of patient-initiated follow-up in surgical practice. This review evaluated whether patient-initiated follow-up safely reduces clinic burden while maintaining patient outcomes across specialties.
methodsMEDLINE, Embase, and CENTRAL were searched (2014-2025) for studies of patient-initiated follow-up, defined as a model enabling clinically stable patients to self-initiate follow-up when new or concerning symptoms arise, rather than attending prearranged appointments. Primary outcomes included outpatient appointment volume and patient-reported quality of life. Where studies reported single-arm utilization data, a random-effects meta-analysis of proportions was undertaken. Exploratory meta-regression examined pathway-level factors associated with utilization. Randomized clinical trials (RCTs) were assessed using the revised Cochrane risk-of-bias 2 tool, observational cohort studies using the Newcastle-Ottawa Scale, and qualitative studies using the Critical Appraisal Skills Programme checklist.
resultsOf 1776 manuscripts identified, 34 studies across 6 surgical specialties (breast, colorectal, otorhinolaryngology, orthopaedics, plastics, and urology) were included: 4 RCTs, 17 observational cohort studies, 11 qualitative studies, and 2 mixed-methods studies. Observational studies consistently reported reductions in routine outpatient attendance-including a reduction from 45·0% to 6·0% in first specialist appointments in patient-initiated follow-up in colorectal surgery (P < 0·001) and 52·5% of patients with high-risk cutaneous squamous cell carcinoma not recontacting the clinic-without evidence of increased adverse outcomes. RCTs demonstrated non-inferior patient-reported quality-of-life outcomes with patient-initiated versus standard follow-up, alongside reductions in physician contact, including a 50% reduction in planned consultations in breast cancer (1·9 versus 3·8 per patient; P < 0·001) and a reduction in specialist contacts from 42·0% to 23·0% in rectal cancer. In a meta-analysis (1806 participants), the pooled patient-initiated follow-up utilization proportion was 0·19 (95% confidence interval 0·09 to 0·36; I2 = 95%), indicating substantial context-dependent variation. In oncological settings-particularly breast, colorectal, melanoma, and head and neck cancer-structured surveillance and rapid-access systems were identified as critical safety adjuncts to implementation.
conclusionPatient-initiated follow-up can reduce outpatient burden in selected surgical populations without compromising patient-reported outcomes; however, its effects are dependent on the clinical context and pathway design. Risk-stratified and hybrid models may be the most appropriate, particularly in oncology. Further high-quality trials and robust economic evaluations are required to define optimal implementation strategies.
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