R. K. Schmocker1, L. Cherney-Stafford1, E. R. Winslow1 1University Of Wisconsin,Surgery,Madison, WI, USA
Introduction: Patient satisfaction is an important component of the patient experience, however measurement of satisfaction with surgical care has been problematic. The recently approved Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) was designed to measure the surgical patient experience. Although previous studies have suggested that satisfaction is not related to postoperative morbidity, this has largely been examined at the hospital level using administrative, measures of morbidity, and more global surveys. We set out to determine, on the patient level, whether the presence of NSQIP complications or other clinical variables impact patient satisfaction on the S-CAHPS.
Methods: All patients undergoing a general surgical operation from 6/13-11/13 were sent the S-CAHPS within 3 days of discharge, with a response rate of 45.3% (456/1007). To assess the impact of malignancy on satisfaction, a subset of operative sites with a high proportion of malignant indications was used (colorectal, thyroid, breast, hepatobiliary). Retrospective chart review was conducted using NSQIP variable definitions. Major complications were defined by the presence of: septic shock, cardiac arrest, stroke, ventilator > 48hrs, unplanned intubation, or organ space infection. Data were analyzed as a function of response to the overall surgeon-rating item, and those surgeons rated as the “best possible” or topbox were compared with those lower ratings using χ2 and t-tests as appropriate.
Results:253 patients were identified, 68% female, with an age of 59±16 yrs, BMI of 28.2±7 kg/m2, and length of stay (LOS) 4.5±6.7 days. 79% of respondents rated the surgeon as topbox. Age, BMI, ASA class, and LOS were similar between those who rated the surgeon as topbox and those that did not. The overall NSQIP complication rate was 20% (48/243) with 23% of those (11/48) being major complications. Neither the complication rate (total or major) nor the number of complications impacted satisfaction scores (Table). Similarly, a malignant indication for the operation, having an urgent operation, or being discharged to somewhere other than home were not associated with satisfaction scores.
Conclusion:Even when examined on a patient-level with surgery-specific measures and outcomes, the presence of complications after an operation does not appear to impact overall patient satisfaction with surgeon care. This, in conjunction with the finding that satisfaction does not appear to be impacted by other important clinical variables such as malignancy, suggests that satisfaction may be an outcome distinct from traditional measures. Further investigation into the primary determinants of this unique outcome is needed.
