Key drivers of patient satisfaction in lumbar spine surgery

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The Patient Experience of Care, composed of 9 dimensions derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, is being used by the Centers for Medicare & Medicaid Services to adjust hospital reimbursement. Currently, there are minimal data on how scores on the constituent HCAHPS items impact the global dimension of satisfaction, the Overall Hospital Rating (OHR). The purpose of this study was to determine the key drivers of overall patient satisfaction in the setting of inpatient lumbar spine surgery.


Demographic and preoperative patient characteristics were obtained. Patients selecting a top-box score for OHR (a 9 or 10 of 10) were considered to be satisfied with their hospital experience. A baseline multivariable logistic regression model was then developed to analyze the association between patient characteristics and top-box OHR. Then, multivariable logistic regression models adjusting for patient-level covariates were used to determine the association between individual components of the HCAHPS survey and a top-box OHR.


A total of 453 patients undergoing lumbar spine surgery were included, 80.1% of whom selected a top-box OHR. Diminishing overall health status (OR 0.63, 95% CI 0.43–0.91) was negatively associated with top-box OHR. After adjusting for potential confounders, the survey items that were associated with the greatest increased odds of selecting a top-box OHR were: staff always did everything they could to help with pain (OR 12.5, 95% CI 6.6–23.7), and nurses were always respectful (OR 11.0, 95% CI 5.3–22.6).


Patient experience of care is increasingly being used to determine hospital and physician reimbursement. The present study analyzed the key drivers of patient experience among patients undergoing lumbar spine surgery and found several important associations. Patient overall health status was associated with top-box OHR. After adjusting for potential confounders, staff always doing everything they could to help with pain and nurses always being respectful were the strongest predictors of overall satisfaction in this population. These findings highlight opportunities for quality improvement efforts in the spine care setting.

ABBREVIATIONS CMS = Centers for Medicare & Medicaid Services; HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems; HVBP = Hospital Value-Based Purchasing; ICD-9 = International Classification of Diseases, Ninth Revision; OHR = Overall Hospital Rating; PDQ = Pain Disability Questionnaire; PHQ-9 = Patient Health Questionnaire 9; TPS = total performance score.

Article Information

Correspondence Jay Levin: Neurological Institute, Cleveland Clinic Center for Spine Health, Cleveland, OH.

INCLUDE WHEN CITING Published online March 23, 2018; DOI: 10.3171/2017.10.SPINE17732.

Disclosures Dr. Mroz: consultant for Stryker and direct stock ownership in PearlDiver. Dr. Steinmetz: royalties from Biomet, Globus, Stryker, Intellirod, and Elsevier.

© AANS, except where prohibited by US copyright law.




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