E. S. Singer1, S. D. Moffatt-Bruce2, D. M. D’Souza2, L. Luo2, R. E. Merritt2, P. J. Kneuertz2 1The Ohio State University, Wexner Medical Center,Department Of Surgery,Columbus, OH, USA 2The Ohio State University, Wexner Medical Center,Thoracic Surgery Division, Department Of Surgery,Columbus, OH, USA
Introduction: Hospital consumer assessment of health care providers and systems (HCAHPS) surveys capture patients’ hospital experience and satisfaction, and are used as a patient-centered quality metric by CMS and hospital administrators. The effects of clinical outcomes on HCAHPS ratings following thoracic surgery are ill defined. We hypothesized that increased length of hospital stay (LOS) and postoperative complications negatively affect HCAHPS scores.
Methods: Patients undergoing lung resection for cancer at a single academic cancer center between years 2014-2018 were analyzed. Clinical data were derived from the institutional Society of Thoracic Surgeons (STS) database and supplemented with HCHAPS survey data. The endpoints were overall top-box satisfaction scores, as well as domain-specific scores in communication with physicians and nurses. Multivariate regression analysis was used to test the association between clinical outcomes and HCAHPS top-box scores.
Results: In total, 181 out of 478 (38%) patients who underwent pulmonary resection for lung cancer completed HCAHPS surveys. Patient median age was 65 years, and most underwent lobectomy (94%). Median LOS was 4 days (IQR 3-6 days). The rate of top-box rating for the overall hospital experience, communication with doctors, and communication with nurses were 92%, 84%, and 69%, respectively. Patient factors associated with lower satisfaction scores with doctors included Asian/Other race and never-smoking status (p=0.02 and p=0.03, respectively). Increasing LOS was associated with worse satisfaction with doctors’ communication (Figure). Overall and major complication rates were 43% and 3% and were not associated with top-box HCAHPS scores. In multivariate analysis adjusted for patient factors, increasing LOS remained independently associated with worse patient satisfaction in the domains of communication with physicians and nurses. Specifically, patients with LOS >6 days compared to LOS <4 days were less likely to endorse top-box scores reflecting that doctors gave understandable explanations (OR 0.15, 95%CI 0.04-0.56) and nurses listened carefully (OR 0.11, 95%CI 0.06-0.69).
Conclusion: Overall HCHAPS satisfaction scores following lung cancer surgery were high and negatively associated with increasing length of stay, but not by postoperative events. Thoracic surgeons should be aware that patient satisfaction may be impacted more by the perception of effective communication during prolonged hospitalizations than by complications.
