Is Patient Satisfaction Associated with 30-day Postoperative Outcomes in a Population Primarily Undergoing Laparoscopic Procedures?

Kristel Lobo Prabhu, MD, Ahmad Elnahas, MD, MSc, FRCSC, Michelle Cleghorn, Allan Okrainec, MDCM, MHPE, FACS, FRCSC, Fayez Quereshy, MD, MBA, FRCSC, Timothy Jackson, MD, MPH, FRCSC, FACS. University Health Network

INTRODUCTION: With the movement towards greater transparency in the reporting of healthcare outcomes, patient satisfaction is becoming a priority.  Ensuring patient satisfaction with their health care encounter plays a key role in delivering quality care. The purpose of this study was to determine the relationship between patient satisfaction and 30-day postoperative outcomes in patients undergoing general surgical procedures.

METHODS AND PROCEDURES: Satisfaction surveys were distributed to patients following discharge from the general surgery service at an academic hospital between June 2012 and March 2015.  The survey required patients to rate their level of satisfaction with services related to their surgery using a 5-point Likert scale. 30-day postoperative outcomes, specifically length of stay (LOS), readmission, and surgical complications, were obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.  Satisfaction ratings were used to divide patients into satisfied (score of 4 or 5) and unsatisfied groups (score of 1 to 3).  Chi-squared analysis was used to compare these cohorts with respect to the proportion of patients experiencing adverse clinical outcomes.

RESULTS: 757 patient satisfaction surveys were completed, representing a 67.5% response rate.  The mean age of patients surveyed was 52.2 years (SD 15.9); 60% of patients were female.  The majority of patients underwent a laparoscopic procedure (85.8%) and were admitted following surgery as inpatients (72%).  91.5% of patients were considered satisfied with their care.  30-day readmission (3.3% vs.12.5% in the satisfied and unsatisfied group, respectively; p<0.01), 30-day minor complications (6.5% vs.17.2%; p<0.01), and 30-day overall complications (9.8% vs.18.8%; p=0.03) were associated with lower patient satisfaction.  Prolonged hospital stay (LOS greater than the sample median) (22.5% vs. 31.2%; p=0.24), and 30-day major complications (3.3% vs.1.6%; p=0.44) were not found to be significantly associated with patient satisfaction.

CONCLUSIONS: Our study found a significant association between patient satisfaction and 30-day readmission and the occurrence of postoperative complications.  Given this association, further study is warranted to evaluate patient satisfaction as a health care quality indicator.

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