关键词: 骨科；人工智能；智慧随访；护理信息化；患者管理

Abstract: Objective: To examine the feasibility and effectiveness of an orthopedic Artificial Intelligence nursing follow-up system in the post-discharge management of surgical patients, to provide a reference for improving the efficiency of follow-up. Methods: Guided by the Interaction Model of Client Health Behavior, follow-up content was designed across four dimensions: health information, emotional support, decision control, and professional guidance. A dual-track mechanism integrating AI-driven automated follow-up and manual intervention was adopted to achieve closed-loop post-discharge management. Results: From December 1, 2024, to September 30, 2025, a total of 11,126 discharged patients in a tertiary grade A hospital in Beijing were included. The system successfully completed follow-up for 9214 cases (82.8%). Using cervical spine surgery as an example, among 3857 discharged patients, 3727 cases (96.6%) were successfully followed up. The system automatically generated 4982 alerts for abnormal findings, primarily related to pain and functional exercise. Conclusion: The Artificial Intelligence nursing follow-up system demonstrates high feasibility and practical value in the post-discharge management of orthopedic surgical patients. It effectively improves follow-up coverage and facilitates the early identification of post-discharge risks.

Key words: orthopedics; Artificial Intelligence; smart follow-up; nursing informatization; patient management