What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement
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Open Access
- 9 April 2013
- Vol. 3 (4), e002525
- https://doi.org/10.1136/bmjopen-2012-002525
Abstract
Objectives To investigate the factors which influence patient satisfaction with surgical services and to explore the relationship between overall satisfaction, satisfaction with specific facets of outcome and measured clinical outcomes (patient reported outcome measures (PROMs)). Design Prospective cohort study. Setting Single National Health Service (NHS) teaching hospital. Participants 4709 individuals undergoing primary lower limb joint replacement over a 4-year period (January 2006–December 2010). Main outcome measures Overall patient satisfaction, clinical outcomes as measured by PROMs (Oxford Hip or Knee Score, SF-12), satisfaction with five specific aspects of surgical outcome, attitudes towards further surgery, length of hospital stay. Results Overall patient satisfaction was predicted by: (1) meeting preoperative expectations (OR 2.62 (95% CI 2.24 to 3.07)), (2) satisfaction with pain relief (2.40 (2.00 to 2.87)), (3) satisfaction with the hospital experience (1.7 (1.45 to 1.91)), (4) 12 months (1.08 (1.05 to 1.10)) and (5) preoperative (0.95 (0.93 to 0.97)) Oxford scores. These five factors contributed to a model able to correctly predict 97% of the variation in overall patient satisfaction response. The factors having greatest effect were the degree to which patient expectations were met and satisfaction with pain relief; the Oxford scores carried little weight in the algorithm. Various factors previously reported to influence clinical outcomes such as age, gender, comorbidities and length of postoperative hospital stay did not help explain variation in overall patient satisfaction. Conclusions Three factors broadly determine the patient's overall satisfaction following lower limb joint arthroplasty; meeting preoperative expectations, achieving satisfactory pain relief, and a satisfactory hospital experience. Pain relief and expectations are managed by clinical teams; however, a fractured access to surgical services impacts on the patient's hospital experience which may reduce overall satisfaction. In the absence of complications, how we deliver healthcare may be of key importance along with the specifics of what we deliver, which has clear implications for units providing surgical services.Keywords
This publication has 28 references indexed in Scilit:
- Is patient reporting of physical function accurate following total knee replacement?The Journal of Bone and Joint Surgery. British volume, 2012
- The effect of surgical factors on early patient-reported outcome measures (PROMS) following total knee replacementThe Journal of Bone and Joint Surgery. British volume, 2012
- Patient expectations of arthroplasty of the hip and kneeThe Journal of Bone and Joint Surgery. British volume, 2012
- Public's satisfaction with NHS fell by 12% in 2011BMJ, 2012
- Quality criteria were proposed for measurement properties of health status questionnairesJournal of Clinical Epidemiology, 2007
- Surgeon communication behaviors that lead patients to not recommend the surgeon to family members or friends: Analysis and impactSurgery, 2006
- Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patientsJournal of Clinical Epidemiology, 2006
- Patients' own assessments of quality of primary care compared with objective records based measures of technical quality of care: cross sectional studyBMJ, 2006
- Patient Outcomes After Knee ReplacementClinical Orthopaedics and Related Research, 1998
- Patient satisfaction as an indicator of quality care.1988