title: Surgical complications impact patient perception of hospital care.
abstract: BACKGROUND
  Public reporting of the Hospital Consumer Assessment of Healthcare Providers and Systems survey is designed to produce data on patients' perceptions of the quality of hospital care. The aim of this study was to assess the impact of complications on patient responses to Hospital Consumer Assessment of Healthcare Providers and Systems "top-box" (most favorable) scores.
  
  
  METHODS
  All patients who underwent a colorectal procedure from October 2009 to June 2012 at a single center were included. Patient complications were categorized as major, minor, or no complications and "surgical technique" or "medical." Chi-square and Wilcoxon rank sum tests were used to compare binary and ordinal top-box scores, respectively.
  
  
  RESULTS
  One thousand four hundred and nine surveys were collected for 1,233 patients (mean age 53 ± 15.7 years; 701 [52.2%] females) who underwent 955 (67.8%) major abdominal, 114 (8.1%) anorectal, and 340 (24.1%) stoma-related operations. There were 195 (13.8%) major and 396 (28.1%) minor complications. There were 159 (11.3%) technique complications and 411 (29.2%) medical complications. Patients without any complications were more likely to recommend the hospital than those with complications (p = 0.023) irrespective of type of complication (minor vs major; p = 0.72 or technique vs medical; p = 0.5). Responsiveness of hospital staff was also reported as higher for patients without complications (p = 0.0003) and the type of complication did not influence this assessment (minor vs major; p = 0.71 and technique vs medical; p = 0.95).
  
  
  CONCLUSIONS
  The occurrence of any complication after colorectal surgery adversely impacts patients' self-reported perceptions of hospital care as measured by Hospital Consumer Assessment of Healthcare Providers and Systems. An instrument that more accurately reflects patients' assessment of quality in the context of variations in patient, disease, and surgical factors is required.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH. Electronic address: gurlanb@ccf.org.
authors.forename: Brooke H
authors.initials: BH
authors.lastname: Gurland
authors.forename: James
authors.initials: J
authors.lastname: Merlino
authors.forename: Tim
authors.initials: T
authors.lastname: Sobol
authors.forename: Patricia
authors.initials: P
authors.lastname: Ferreira
authors.forename: Tracy
authors.initials: T
authors.lastname: Hull
authors.forename: Massarat
authors.initials: M
authors.lastname: Zutshi
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D003108:Colonic Diseases / Q000601:surgery; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000523:psychology*; D011787:Quality of Health Care; D012002:Rectal Diseases / Q000601:surgery; D011795:Surveys and Questionnaires