Predictors of patient satisfaction and survey participation after spine surgery: a retrospective review of 17,853 consecutive spinal patients from a single academic institution. Part 2: HCAHPS

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OBJECTIVE

Patient satisfaction is a new and important metric in the American healthcare system. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a common modality used to assess patient satisfaction in inpatient settings. Despite the existence of data, neurosurgical literature on patient satisfaction following spinal surgery is scarce.

METHODS

A total of 17,853 patients who underwent spinal procedures at the authors’ institution were analyzed retrospectively for HCAHPS survey participation. Appropriate demographic, surgical, comorbidity, and complication data were collected; 1118 patients had patient satisfaction survey data, and further survey metrics were collected for this subset of patients.

RESULTS

Male patients, patients with urgent/emergency procedures, and patients with a longer length of stay were less likely to complete an HCAHPS survey (OR 0.820, p < 0.001; OR 0.818, p = 0.042; and OR 0.983, p < 0.001, respectively). Posterior approach was negatively associated with HCAHPS survey participation (OR 0.868, p = 0.007). Patients undergoing fusion procedures were more likely to participate in HCAHPS surveys (OR 1.440, p < 0.001). Of the completed HCAHPS surveys, there were no positive predictors associated with perfect scores. High Charlson Comorbidity Index (OR 0.931, p = 0.007), increasing elapsed time since surgery or discharge (OR 0.992, p = 0.004), and increasing length of stay (OR 0.928, p < 0.001) were all negatively associated with a perfect score. Finally, patient sex and race did not influence the likelihood of a perfect or low survey score.

CONCLUSIONS

Participation in HCAHPS surveys was correlated with preoperative and postoperative factors. Among these, procedure approach and type, length of stay, and complications seemed to influence participation the most. No factors were associated with an increased likelihood of receiving a perfect score. Similarly, length of stay and time elapsed since surgery to survey completion were significant negative predictors of receiving perfect HCAHPS survey scores. Increasing comorbid burden was also found to be a negative predictor for high scores. Further study on predictors of inpatient satisfaction within spine surgery is needed.

ABBREVIATIONS CCI = Charlson Comorbidity Index; CMS = Centers for Medicare & Medicaid Services; EDW = Electronic Data Warehouse; HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems; LOS = length of stay; MI = myocardial ischemia; VTE = venous thromboembolism.
Article Information

Contributor Notes

Correspondence Nader S. Dahdaleh: Northwestern University Feinberg School of Medicine, Chicago, IL. nader.dahdaleh@northwestern.edu.INCLUDE WHEN CITING Published online January 4, 2019; DOI: 10.3171/2018.8.SPINE181024.

B.S.H. and M.R.P. contributed equally to this manuscript and share first authorship.

Disclosures Dr. Dahdaleh: consultant for DePuy, Spinal Elements, and Stryker.

© AANS, except where prohibited by US copyright law.

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