November 22, 2018 / 5:55 PM / a month ago

Patient satisfaction not influenced by surgery complications

(Reuters Health) - Patients’ satisfaction with surgeon care doesn’t seem to be tied to whether or not they have complications after a procedure, a small U.S. study suggests.

Researchers compared how 529 patients rated their surgeons in satisfaction surveys after their operations and the number and severity of any complications these patients might have experienced.

Overall, 72 percent of the patients rated their surgeons as the “best possible” in satisfaction surveys.

Fourteen percent of patients had complications after their operations, and about 27 percent of these were major or severe complications.

But neither the number of complications nor the severity of complications appeared to influence whether patients gave their surgeons top marks in satisfaction surveys, researchers report in the journal Surgery.

“Patient satisfaction with surgical care is about much more than the established quality metrics can measure - it is primarily a surrogate for effective communication and compassion, as well as competent longitudinal care and getting people safely through the expected complications after operations,” said senior study author Dr. Emily Winslow of the University of Wisconsin School of Medicine and Public Health in Madison.

With factors like patient satisfaction increasingly tied to reimbursements, Winslow’s team set out to see how well it lines up with a more traditional factor used to assess quality of surgical care: complication rates.

These results don’t necessarily mean that satisfaction surveys are inaccurate, Winslow said by email. But it does suggest that assessments of surgical quality that focus only on complications may not capture all the factors that can influence how patients feel afterwards.

“Although complication rates should be lowered as much as possible, there is much more to high quality care of surgical patients than low complication rates, and it is those other things that we do not currently measure well and that patient satisfaction scores indirectly capture,” Winslow added.

Patients who gave their surgeons higher ratings tended to be older, having elective rather than emergency procedures, and having operations for cancer.

It’s hard to be sure why patient satisfaction didn’t appear related to complication rates, said Dr. Anupam Jena, a researcher at Harvard Medical School and Massachusetts General Hospital in Boston who wasn’t involved in the study.

“It may be that some patients view complications of surgery as being ‘par for the course’, either because they entered the surgery believing that or that is suggested to them when complications occur,” Jena said by email.

“Factors like a surgeon’s communication after a complication may also mitigate the negative effects of the complication on patient experience,” Jena added. “An honest and forthcoming surgeon with a good bedside manner may be reassuring to a patient who experienced a complication after surgery.”

One limitation of the study is that the patient satisfaction surveys didn’t include questions about how people felt about the care they received after their operations, the study authors note. The study was also done at a single medical center with a predominantly white patient base, and it’s possible results might be different elsewhere.

Even so, the findings confirm what’s been seen in many previous studies examining patient satisfaction and outcomes from surgery as well as from other types of treatment, said Dr. Karl Bilimoria, vice president for quality at Northwestern Medicine in Chicago.

“Patient experience is not a reflection of patient complications or other typical measures of healthcare quality,” Bilimoria, who wasn’t involved in the current study, said by email.

“This does not mean that we are measuring patient experience incorrectly - quite the contrary,” Bilimoria said. “These findings emphasize the need to continue to measure patient experience and report it publicly, as it provides information about the quality of care that is not assessed from other available metrics.”

SOURCE: bit.ly/2DeWnBM Surgery, online October 12, 2018.

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