title: Surgical inpatient satisfaction: what are the real drivers?
abstract: BACKGROUND
  Inpatient satisfaction is a key element of hospital pay-for-performance programs. Communication and pain management are known to influence results, but additional factors may affect satisfaction scores. We tested the hypothesis that patient factors and outcome parameters not considered previously are clinically important drivers of inpatient satisfaction.
  
  
  METHODS
  Medical records were reviewed for 1,340 surgical patients who returned nationally standardized inpatient satisfaction questionnaires. These patients were managed by 41 surgeons in seven specialties at two academic medical centers. Thirty-two parameters based on the patient, surgeon, outcomes, and survey were measured. Univariate and multivariable analyses were performed.
  
  
  RESULTS
  Inpatients rated their overall experience favorably 75.7% of the time. Less-satisfied patients were more likely to be female, younger, less ill, taking outpatient narcotics, and admitted via the emergency department (all P < .02). Less-satisfied patients also were more likely to have unresected cancer (P < .001) or a postoperative complication (P < .001). The most relevant independent predictors of dissatisfaction in multivariable analyses were younger age, admission via the emergency department, preoperative narcotic use, lesser severity of illness, unresected cancer, and postoperative morbidity (all P < .01).
  
  
  CONCLUSIONS
  Several patient factors, expectations of patients with cancer, and postoperative complications are important and clinically relevant drivers of surgical inpatient satisfaction. Programs to manage expectations of cancer patient expectations and decrease postoperative morbidity should improve surgical inpatient satisfaction. Further efforts to risk-adjust patient satisfaction scores should be undertaken.
authors: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors: Rachel M
authors: RM
authors: Danforth
authors: Department of Surgery, Temple University School of Medicine, Philadelphia, PA. Electronic address: Henry.Pitt@tuhs.temple.edu.
authors: Henry A
authors: HA
authors: Pitt
authors: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors: Mindy E
authors: ME
authors: Flanagan
authors: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors: Benjamin D
authors: BD
authors: Brewster
authors: Decision Support, Indiana University Health, Indianapolis, IN.
authors: Elizabeth W
authors: EW
authors: Brand
authors: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors: Richard M
authors: RM
authors: Frankel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007196:Indiana; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D012052:Reimbursement, Incentive; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000191:economics; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult