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Andrew A. Ronald, Vineeth Sadda, Nicholas M. Rabah, and Michael P. Steinmetz

OBJECTIVE

Patient complaints are associated with a number of surgical and medical outcomes. Despite high rates of patient complaints regarding spine surgeons and efforts to study patient complaints across medicine and surgery, few studies have analyzed the complaints of patients undergoing spinal surgery. The authors present a retrospective analysis that, to their knowledge, is the first study to directly investigate the complaints of spine surgery patients in the postoperative period.

METHODS

Institutional records were reviewed over a 5-year period (2015–2019) to identify patients who underwent spine surgery and submitted a complaint to the institution’s ombudsman’s office within 1 year of their surgery. A control group, comprising patients who underwent spine surgery without filing a complaint, was matched to the group that filed complaints by admission diagnosis and procedure codes through propensity score matching. Patient demographic and clinical data were obtained by medical record review and compared between the two groups. Patient complaints were reviewed and categorized using a previously established taxonomy.

RESULTS

A total of 52 patients were identified who submitted a complaint after their spine surgery. There were 56 total complaints identified (4 patients submitted 2 each) that reported on 82 specific issues. Patient complaints were most often related to the quality of care received and communication breakdown between the healthcare team and the patient. Patients who submitted complaints were more likely to be Black or African American, have worse baseline health status, and have had prior spine surgery. After their surgery, these patients were also more likely to have longer hospital stays, experience postoperative complications, and require reoperation.

CONCLUSIONS

Complaints were most often related to the quality of care received and communication breakdown. A number of patient-level demographic and clinical characteristics were associated with an increased likelihood of a complaint being filed after spine surgery, and patients who filed complaints were more likely to experience postoperative complications. Improving communication with patients could play a key role in working to address and reduce postoperative complaints. Further study is needed to better understand patient complaints after spine surgery and investigate ways to optimize the care of patients with risks for postoperative complaints.

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Nicholas M. Rabah, Hammad A. Khan, Robert D. Winkelman, Jay M. Levin, Thomas E. Mroz, and Michael P. Steinmetz

OBJECTIVE

The Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) was developed as a result of the value-based purchasing initiative by the Center for Medicare & Medicaid Services. It allows patients to rate their experience with their provider in the outpatient setting. These ratings are then reported in aggregate and made publicly available, allowing patients to make informed choices during physician selection. In this study, the authors sought to elucidate the primary drivers of patient satisfaction in the office-based spine surgery setting as represented by the CG-CAHPS.

METHODS

All patients who underwent lumbar spine surgery between 2009 and 2017 and completed a patient experience survey were studied. The satisfied group comprised patients who selected a top-box score (9 or 10) for overall provider rating (OPR) on the CG-CAHPS, while the unsatisfied group comprised the remaining patients. Demographic and surgical characteristics were compared using the chi-square test for categorical variables and the Student t-test for continuous variables. A multivariable logistic regression model was developed to analyze the association of patient and surgeon characteristics with OPR. Survey items were then added to the baseline model individually, adjusting for covariates.

RESULTS

The study population included 647 patients who had undergone lumbar spine surgery. Of these patients, 564 (87%) selected an OPR of 9 or 10 on the CG-CAHPS and were included in the satisfied group. Patient characteristics were similar between the two groups. The two groups did not differ significantly regarding patient-reported health status measures. After adjusting for potential confounders, the following survey items were associated with the greatest odds of selecting a top-box OPR: did this provider show respect for what you had to say? (OR 21.26, 95% CI 9.98–48.10); and did this provider seem to know the important information about your medical history? (OR 20.93, 95% CI 11.96–45.50).

CONCLUSIONS

The present study sought to identify the key drivers of patient satisfaction in the postoperative office-based spine surgery setting and found several important associations. After adjusting for potential confounders, several items relating to physician communication were found to be the strongest predictors of patient satisfaction. This highlights the importance of effective communication in the patient-provider interaction and elucidates avenues for quality improvement efforts in the spine care setting.

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Nicholas M. Rabah, Hammad A. Khan, Jay M. Levin, Robert D. Winkelman, Thomas E. Mroz, and Michael P. Steinmetz

OBJECTIVE

The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey was developed by the Centers for Medicare and Medicaid Services as a result of their value-based purchasing initiative. It allows patients to rate their experience with their provider in the outpatient setting. This presents a unique situation in healthcare in which the patient experience drives the marketplace, and since its creation, providers have sought to improve patient satisfaction. Within the spine surgery setting, however, the question remains whether improved patient satisfaction correlates with improved outcomes.

METHODS

All patients who had undergone lumbar spine surgery between 2009 and 2017 and who completed a CG-CAHPS survey after their procedure were studied. Demographic and surgical characteristics were then obtained. The primary outcomes of this study include patient-reported health outcomes measures such as the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) surveys for both mental health (PROMIS-GH-MH) and physical health (PROMIS-GH-PH), and the visual analog scale for back pain (VAS-BP). A multivariable linear regression analysis was used to assess whether patient satisfaction with their provider was associated with changes in each health status measure after adjusting for potential confounders.

RESULTS

The study population included 647 patients who had undergone lumbar spine surgery. Of these, 564 (87%) indicated that they were satisfied with the care they received. Demographic and surgical characteristics were largely similar between the two groups. Multivariable linear regression demonstrated that patient satisfaction with their provider was not a significant predictor of change in two of the three patient-reported outcomes (PROMIS-GH-MH and PROMIS-GH-PH) assessed at 1 year. However, top-box patient satisfaction with their provider was a significant predictor of improvement in VAS-BP scores at 1 year.

CONCLUSIONS

The authors found that after adjusting for patient-level covariates such as age, diagnosis of disc displacement, self-reported mental health, self-reported overall health, and preoperative patient-reported outcome measure status, a significant association was observed between top-box overall provider rating and 1-year improvement in VAS-BP, but no such association was observed for PROMIS-GH-PH and PROMIS-GH-MH. This suggests that pain-related outcome measures may serve as better predictors of patients’ satisfaction with their spine surgeons. Furthermore, this suggests that the current method by which patient satisfaction is being assessed and publicly reported may not necessarily correlate with validated measures that are used within the spine surgery setting to assess surgical efficacy.