Impact of length of stay on HCAHPS scores following lumbar spine surgery

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OBJECTIVE

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures.

METHODS

The authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of “top-box” (“9–10” or “always or usually”) versus “low-box” (“1–8” and “somewhat or never”) scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher’s exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables.

RESULTS

Two hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control.

CONCLUSIONS

Here, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.

ABBREVIATIONS CMS = Centers for Medicare and Medicaid Services; GTE-LOS = LOS greater than expected; HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems; LOS = length of stay; LTE-LOS = LOS less than expected; MS-DRG = Medicare Severity Diagnosis Related Group; NRS = numeric rating scale; PDQ = Pain Disability Questionnaire; PHQ-9 = Patient Health Questionnaire 9.

Article Information

Correspondence Gabriel A. Smith: Center for Spine Health, Cleveland Clinic Foundation, Cleveland, OH. gabriel.smith@uhhospitals.org.

INCLUDE WHEN CITING Published online May 31, 2019; DOI: 10.3171/2019.3.SPINE181180.

Disclosures Dr. Mroz has been a consultant for Stryker and has direct stock ownership in PearlDiver. Dr. Steinmetz has been a consultant for Globus and Intellirod; has received honoraria from Stryker and Globus; and has received royalties from Zimmer Biomet.

© AANS, except where prohibited by US copyright law.

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