Association Between Patient-Reported Measures of Psychological Distress and Patient Satisfaction Scores in a Spine Surgery Patient Population

e15567 Background: Esophagectomy is accompanied by significant morbidity, mortality and altered quality of life. Understanding the factors responsible for adverse post-operative outcomes is essential for risk stratification in the selection of patients for surgery. Patient-reported measures are important not only as treatment outcome metrics, but also in predicting tolerance to therapy. Postoperative length of stay is a convenient measurement of patient tolerance of surgery. Our study aim was to determine whether preoperative patient-reported measures could add additional predictive power to clinical variables in predicting postoperative length of stay. Methods: A tablet-based symptom screening tool measured Distress, Anxiety (GAD-2), and cancer-related symptoms preoperatively. A generalized linear model predicting postoperative length of stay was constructed using age, gender, insurance status, income, T stage, and sarcopenia (hand-grip strength < 25kg). Patient-reported variables were then evaluated for their ability to predict length of stay in addition to these clinical factors. Factors found not significant (p > 0.05) are indicated N.S. Results: Esophagectomy (n = 58): Median age 62 (IQR 54-70) and 46 men (79%). Adenocarcinoma in 52 (90%). Neoadjuvant chemoradiation administered in 37 (64%). Major complications occurred in 13 (22%). Median postoperative length of stay was 8 days (IQR 6-10). Distress, Pain, Nausea/Vomiting, Trouble Swallowing, and Insurance or Financial Concerns independently predicted postoperative longer length of stay on multivariable analysis, while accounting for preoperative clinical factors. Conclusions: Preoperative cancer patient symptom reporting adds additional information to traditional clinical factors in predicting length of stay post-esophagectomy. Patient-reported measures may identify patients who benefit from interventions for preoperative optimization.[Table: see text]

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Association of Patient-Reported Readiness for Discharge and Hospital Consumer Assessment of Health Care Providers and Systems Patient Satisfaction Scores: A Retrospective Analysis

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2015.09.009 ◽

2015 ◽

Vol 221 (6) ◽

pp. 1073-1082.e3 ◽

Cited By ~ 11

Author(s):

Ryan K. Schmocker ◽

Sara E. Holden ◽

Xia Vang ◽

Glen E. Leverson ◽

Linda M. Cherney Stafford ◽

...

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Retrospective Analysis ◽

Health Care Providers ◽

Care Providers ◽

Patient Satisfaction Scores ◽

Patient Reported ◽

Hospital Consumer Assessment ◽

Consumer Assessment

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Association Between Nonmodifiable Demographic Factors and Patient Satisfaction Scores in Spine Surgery Clinics

Orthopedics ◽

10.3928/01477447-20190424-05 ◽

2019 ◽

Vol 42 (3) ◽

pp. 143-148 ◽

Cited By ~ 2

Author(s):

Bradley C. Johnson ◽

Dennis Vasquez-Montes ◽

Leah Steinmetz ◽

Aaron J. Buckland ◽

John A. Bendo ◽

...

Keyword(s):

Patient Satisfaction ◽

Spine Surgery ◽

Demographic Factors ◽

Patient Satisfaction Scores

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Benchmarking patient satisfaction scores in a colorectal patient population

Surgical Endoscopy ◽

10.1007/s00464-020-07401-1 ◽

2020 ◽

Vol 35 (1) ◽

pp. 309-316

Author(s):

Sandra L. Kavalukas ◽

Rebeccah B. Baucom ◽

Timothy M. Geiger ◽

Molly M. Ford ◽

Roberta L. Muldoon ◽

...

Keyword(s):

Patient Satisfaction ◽

Patient Population ◽

Patient Satisfaction Scores

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Patient-Reported and Performance-Based Measures and Patient Satisfaction following Spine Surgery: A Longitudinal Analysis

The Spine Journal ◽

10.1016/j.spinee.2015.07.102 ◽

2015 ◽

Vol 15 (10) ◽

pp. S123

Author(s):

Kristin Archer ◽

John A. Sielatycki ◽

Rogelio Coronado ◽

Stephen Wegener ◽

Joseph S. Cheng ◽

...

Keyword(s):

Patient Satisfaction ◽

Spine Surgery ◽

Longitudinal Analysis ◽

Patient Reported ◽

And Performance

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Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20592 ◽

2021 ◽

Vol 34 (1) ◽

pp. 73-82 ◽

Cited By ~ 1

Author(s):

Christine Park ◽

Alessandra N. Garcia ◽

Chad Cook ◽

Christopher I. Shaffrey ◽

Oren N. Gottfried

Keyword(s):

Patient Satisfaction ◽

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Normal Weight ◽

Lumbar Spine Surgery ◽

Morbidly Obese ◽

Lumbar Surgery ◽

Patient Reported

OBJECTIVEObese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.METHODSA search was performed using the Quality Outcomes Database (QOD) Spine Registry from 2012 to 2018 to identify patients who underwent lumbar surgery and had either a 12- or 24-month follow-up. Patients were categorized based on their BMI as normal weight (≤ 25 kg/m2), overweight (25–30 kg/m2), obese (30–40 kg/m2), and morbidly obese (> 40 kg/m2). Outcomes included the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for back pain (BP) and leg pain (LP), and patient satisfaction was measured at 12 and 24 months postoperatively.RESULTSA total of 31,765 patients were included. At both the 12- and 24-month follow-ups, those who were obese and morbidly obese had worse ODI, VAS-BP, and VAS-LP scores (all p < 0.01) and more frequently rated their satisfaction as “I am the same or worse than before treatment” (all p < 0.01) compared with those who were normal weight. Receiver operating characteristic curve analysis revealed that the BMI cutoffs for predicting worsening disability and surgery dissatisfaction were 30.1 kg/m2 and 29.9 kg/m2 for the 12- and 24-month follow-ups, respectively.CONCLUSIONSHigher BMI was associated with poorer patient-reported outcomes and satisfaction at both the 12- and 24-month follow-ups. BMI of 30 kg/m2 is the cutoff for predicting worse patient outcomes after lumbar surgery.

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Key drivers of patient satisfaction with spine surgeons in the outpatient setting

Journal of Neurosurgery Spine ◽

10.3171/2020.9.spine201292 ◽

2021 ◽

pp. 1-8

Author(s):

Nicholas M. Rabah ◽

Hammad A. Khan ◽

Robert D. Winkelman ◽

Jay M. Levin ◽

Thomas E. Mroz ◽

...

Keyword(s):

Patient Satisfaction ◽

Lumbar Spine ◽

Spine Surgery ◽

Outpatient Setting ◽

Categorical Variables ◽

Lumbar Spine Surgery ◽

Continuous Variables ◽

Multivariable Logistic Regression Model ◽

Patient Reported ◽

Key Drivers

OBJECTIVE The Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) was developed as a result of the value-based purchasing initiative by the Center for Medicare & Medicaid Services. It allows patients to rate their experience with their provider in the outpatient setting. These ratings are then reported in aggregate and made publicly available, allowing patients to make informed choices during physician selection. In this study, the authors sought to elucidate the primary drivers of patient satisfaction in the office-based spine surgery setting as represented by the CG-CAHPS. METHODS All patients who underwent lumbar spine surgery between 2009 and 2017 and completed a patient experience survey were studied. The satisfied group comprised patients who selected a top-box score (9 or 10) for overall provider rating (OPR) on the CG-CAHPS, while the unsatisfied group comprised the remaining patients. Demographic and surgical characteristics were compared using the chi-square test for categorical variables and the Student t-test for continuous variables. A multivariable logistic regression model was developed to analyze the association of patient and surgeon characteristics with OPR. Survey items were then added to the baseline model individually, adjusting for covariates. RESULTS The study population included 647 patients who had undergone lumbar spine surgery. Of these patients, 564 (87%) selected an OPR of 9 or 10 on the CG-CAHPS and were included in the satisfied group. Patient characteristics were similar between the two groups. The two groups did not differ significantly regarding patient-reported health status measures. After adjusting for potential confounders, the following survey items were associated with the greatest odds of selecting a top-box OPR: did this provider show respect for what you had to say? (OR 21.26, 95% CI 9.98–48.10); and did this provider seem to know the important information about your medical history? (OR 20.93, 95% CI 11.96–45.50). CONCLUSIONS The present study sought to identify the key drivers of patient satisfaction in the postoperative office-based spine surgery setting and found several important associations. After adjusting for potential confounders, several items relating to physician communication were found to be the strongest predictors of patient satisfaction. This highlights the importance of effective communication in the patient-provider interaction and elucidates avenues for quality improvement efforts in the spine care setting.

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Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2017.12.spine171079 ◽

2018 ◽

Vol 29 (1) ◽

pp. 40-45 ◽

Cited By ~ 8

Author(s):

Aladine A. Elsamadicy ◽

Hanna Kemeny ◽

Owoicho Adogwa ◽

Eric W. Sankey ◽

C. Rory Goodwin ◽

...

Keyword(s):

Patient Satisfaction ◽

Lumbar Spine ◽

Racial Disparities ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Readmission Rates ◽

Patient Reported ◽

Short And Long Term ◽

Satisfaction Measures

OBJECTIVEIn spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient-reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence that racial disparities have on short- and long-term PROs and patient satisfaction after spine surgery is relatively unknown. The aim of this study was to investigate the impact of racial disparities on 3- and 12-month PROs and patient satisfaction after elective lumbar spine surgery.METHODSThis study was designed as a retrospective analysis of a prospectively maintained database. The medical records of adult (age ≥ 18 years) patients who had undergone elective lumbar spine surgery for spondylolisthesis (grade 1), disc herniation, or stenosis at a major academic institution were included in this study. Patient demographics, comorbidities, postoperative complications, and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient-reported outcome instruments—Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP), and VAS for leg pain (VAS-LP)—were completed before surgery and at 3 and 12 months after surgery, as were patient satisfaction measures.RESULTSThe authors identified 345 medical records for 53 (15.4%) African American (AA) patients and 292 (84.6%) white patients. Baseline patient demographics and comorbidities were similar between the two cohorts, with AA patients having a greater body mass index (33.1 ± 6.6 vs 30.2 ± 6.4 kg/m2, p = 0.005) and a higher prevalence of diabetes (35.9% vs 16.1%, p = 0.0008). Surgical indications, operative variables, and postoperative variables were similar between the cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater baseline ODI (p < 0.0001), VAS-BP score (p = 0.0002), and VAS-LP score (p = 0.0007). However, mean changes from baseline to 3- and 12-month PROs were similar between the cohorts for all measures except the 3-month VAS-BP score (p = 0.046). Patient-reported satisfaction measures at 3 and 12 months demonstrated a significantly lower proportion of AA patients stating that surgery met their expectations (3 months: 47.2% vs 65.5%, p = 0.01; 12 months: 35.7% vs 62.7%, p = 0.007).CONCLUSIONSThe study data suggest that there is a significant difference in the perception of health, pain, and disability between AA and white patients at baseline and short- and long-term follow-ups, which may influence overall patient satisfaction. Further research is necessary to identify patient-specific factors associated with racial disparities that may be influencing outcomes to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.

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The association between patient rating of their spine surgeon and quality of postoperative outcome

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20478 ◽

2020 ◽

pp. 1-7

Author(s):

Nicholas M. Rabah ◽

Hammad A. Khan ◽

Jay M. Levin ◽

Robert D. Winkelman ◽

Thomas E. Mroz ◽

...

Keyword(s):

Mental Health ◽

Patient Satisfaction ◽

Lumbar Spine ◽

Linear Regression ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Linear Regression Analysis ◽

Lumbar Spine Surgery ◽

Patient Rating ◽

Patient Reported

OBJECTIVEThe Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey was developed by the Centers for Medicare and Medicaid Services as a result of their value-based purchasing initiative. It allows patients to rate their experience with their provider in the outpatient setting. This presents a unique situation in healthcare in which the patient experience drives the marketplace, and since its creation, providers have sought to improve patient satisfaction. Within the spine surgery setting, however, the question remains whether improved patient satisfaction correlates with improved outcomes.METHODSAll patients who had undergone lumbar spine surgery between 2009 and 2017 and who completed a CG-CAHPS survey after their procedure were studied. Demographic and surgical characteristics were then obtained. The primary outcomes of this study include patient-reported health outcomes measures such as the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) surveys for both mental health (PROMIS-GH-MH) and physical health (PROMIS-GH-PH), and the visual analog scale for back pain (VAS-BP). A multivariable linear regression analysis was used to assess whether patient satisfaction with their provider was associated with changes in each health status measure after adjusting for potential confounders.RESULTSThe study population included 647 patients who had undergone lumbar spine surgery. Of these, 564 (87%) indicated that they were satisfied with the care they received. Demographic and surgical characteristics were largely similar between the two groups. Multivariable linear regression demonstrated that patient satisfaction with their provider was not a significant predictor of change in two of the three patient-reported outcomes (PROMIS-GH-MH and PROMIS-GH-PH) assessed at 1 year. However, top-box patient satisfaction with their provider was a significant predictor of improvement in VAS-BP scores at 1 year.CONCLUSIONSThe authors found that after adjusting for patient-level covariates such as age, diagnosis of disc displacement, self-reported mental health, self-reported overall health, and preoperative patient-reported outcome measure status, a significant association was observed between top-box overall provider rating and 1-year improvement in VAS-BP, but no such association was observed for PROMIS-GH-PH and PROMIS-GH-MH. This suggests that pain-related outcome measures may serve as better predictors of patients’ satisfaction with their spine surgeons. Furthermore, this suggests that the current method by which patient satisfaction is being assessed and publicly reported may not necessarily correlate with validated measures that are used within the spine surgery setting to assess surgical efficacy.

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