Impact of surgical approach and patient factors on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scoring in gynecologic surgery

Objective We sought to compare the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey responses of women who underwent gynecologic surgery at our institution across patient factors and surgical approach. Methods We identified patients with returned HCAHPS surveys following an inpatient laparoscopic surgery or laparotomy in gynecologic surgery from 10/1/2012–9/30/2015. Exclusions included patient age < 18 years, discharge by a service other than Gynecologic Surgery, or refusal of Minnesota research authorization. HCAHPS composite measures were calculated using published top-box and summary star rating methodologies and dichotomized as “high” versus “low.” Chi-square, Fisher's exact, and Wilcoxon rank sum tests, and multivariable logistic regression were performed. Results Of 403 women who met inclusion criteria, 109 (27%) underwent laparoscopic surgery (19% laparoscopic hysterectomy and 8% other laparoscopic procedures) and 294 (73%) laparotomy (28% open hysterectomy and 47% other open procedures). Length of stay (LOS) was longer for laparotomy cases vs. laparoscopy cases (median 2.5 days following open hysterectomy and 4 days following other open procedures vs 1 day following laparoscopic hysterectomy and other laparoscopic procedures, p < 0.001). Patients who underwent laparotomy other than hysterectomy were more likely to have low summary scores (79% vs 66% laparoscopic hysterectomy, 66% open hysterectomy, and 52% other laparoscopic procedures, p = 0.005). After adjustment, non-hysterectomy laparotomy cases were more likely to have a low summary score than non-hysterectomy laparoscopy (OR 3.86, 95% CI 1.71–8.68, p = 0.001). This significance did not remain after further adjusting for LOS. Conclusion In Gynecologic Surgery, patients undergoing laparotomy gave lower hospital ratings compared to laparoscopy. Those with longer LOS reported poorer patient experience, which is the driving variable for lower scores. In the future, it may be necessary to adjust for surgical approach when reporting patient experience scoring.