Impact of length of stay on HCAHPS scores following lumbar spine surgery.
OBJECTIVE
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures.


METHODS
The authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of "top-box" ("9-10" or "always or usually") versus "low-box" ("1-8" and "somewhat or never") scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher's exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables.


RESULTS
Two hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control.


CONCLUSIONS
Here, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.
['Smith|Gabriel A|GA|', 'Chirieleison|Steven|S|', 'Levin|Jay|J|', 'Atli|Karam|K|', 'Winkelman|Robert|R|', 'Tanenbaum|Joseph E|JE|', 'Mroz|Thomas|T|', 'Steinmetz|Michael|M|']
D000328:Adult D000368:Aged D005260:Female D006761:Hospitals D006801:Humans D007902:Length of Stay D008159:Lumbar Vertebrae D008297:Male D008875:Middle Aged D019635:Neurosurgical Procedures D017060:Patient Satisfaction D011184:Postoperative Period D012189:Retrospective Studies D011795:Surveys and Questionnaires
length of stay HCAHPS reimbursement CMS = Centers for Medicare and Medicaid Services GTE-LOS = LOS greater than expected HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems LOS = length of stay LTE-LOS = LOS less than expected MS-DRG = Medicare Severity Diagnosis Related Group NRS = numeric rating scale PDQ = Pain Disability Questionnaire PHQ-9 = Patient Health Questionnaire 9 functional outcomes lumbar surgery