Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3486–3493 | Cite as

Association Between Patient Satisfaction and Short-Term Outcomes After Major Cancer Surgery

  • Deborah R. Kaye
  • Caroline R. Richardson
  • Zaojun Ye
  • Lindsey A. Herrel
  • Chad Ellimoottil
  • David C. Miller
Health Services Research and Global Oncology



The aim of this study was to investigate whether patient satisfaction, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, is associated with short-term outcomes after major cancer surgery.

Materials and Methods

We first used national Medicare claims to identify patients who underwent a major extirpative cancer surgery from 2011 to 2013. Next, we used Hospital Compare data to assign the HCAHPS score to the hospital where the patient underwent surgery. We then performed univariate statistical analyses and fit multilevel logistic regression models to evaluate the relationship between excellent patient satisfaction and short-term cancer surgery outcomes for all surgery types combined and then by each individual surgery type.


We identified 373,692 patients who underwent major cancer surgery for one of nine cancers at 2617 hospitals. In both unadjusted and adjusted analyses, hospitals with higher proportions of patients reporting excellent satisfaction had lower complication rates (p < 0.001), readmissions (p < 0.001), mortality (p < 0.001), and prolonged length of stay (p < 0.001) than hospitals with lower proportions of satisfied patients, but with modest differences. This finding held true broadly across individual cancer types for complications, mortality, and prolonged length of stay, but less so for readmissions.


Hospital-wide excellent patient satisfaction scores are associated with short-term outcomes after major cancer surgery overall, but are modest in magnitude.



David C. Miller and Deborah R. Kaye received the support from National Cancer Institute (Grant Nos. 1-R01-CA-174768-01-A1 and 5-T32-CA-180984-03).


Dr. Miller receives salary support from Blue Cross Blue Shield of Michigan for his work in the Michigan Value Collaborative and as director of the Michigan Urological Surgery Improvement Collaborative. Dr. Ellimoottil receives salary support for his role as the director of analytics for the Michigan Value Collaborative.

Supplementary material

10434_2017_6049_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 47 kb)


  1. 1.
    Centers for Medicare & Medicaid Services (CMS). Hospital value based purchasing. CMS; 2015.Google Scholar
  2. 2.
    Centers for Medicare & Medicaid Services. HCAHPS: patients’ perspectives of care survey; 2014.Google Scholar
  3. 3.
    Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). hcahpsonline, The HCAHPS survery: frequently asked questions.Google Scholar
  4. 4.
    Shirk JD, Tan HJ, Hu JC, Saigal CS, Litwin M. Patient experience and quality of urologic cancer surgery in US hospitals. Cancer. 2016;122(16):2571–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Gurland BH, Merlino J, Sobol T, et al. Surgical complications impact patient perception of hospital care. J Am Coll Sur. 2013;217(5):843–9.CrossRefGoogle Scholar
  6. 6.
    Centers for Medicare & Medicaid Services. HCAHPS: patients perspectives of care survey. 2014.Google Scholar
  7. 7.
    Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). hcahpsonline, HCAHPS fact sheet (CAHPS Hospital Survey). 2009.Google Scholar
  8. 8.
    Centers for Medicare & and Medicaid Services. Datasets. 2016.
  9. 9.
    Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ perception of hospital care in the United States. N Engl J Med. 2008;359(18):1921–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Iezzoni LI, Mackiernan YD, Cahalane MJ, Phillips RS, Davis RB, Miller K. Screening inpatient quality using post-discharge events. Med Care. 1999;37(4):384–98.CrossRefPubMedGoogle Scholar
  11. 11.
    Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA. 2015;313(5):496–504.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Tan HJ, Norton EC, Ye Z, Hafez KS, Gore JL, Miller DC. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012;307(15):1629–35.CrossRefPubMedGoogle Scholar
  13. 13.
    Herrel LA, Norton EC, Hawken SR, Ye Z, Hollenbeck BK, Miller DC. Early impact of Medicare accountable care organizations on cancer surgery outcomes. Cancer. 2016;122(17):2739–46.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Salinas SR. examining the relationship between perceived quality of care and actual quality of care as measured by 30-day readmission rates. Qual Manag Health Care. 2017;26(1):29–32.PubMedGoogle Scholar
  15. 15.
    Joseph B, Azim A, O’Keeffe T, et al. American College of Surgeons Level I trauma centers outcomes do not correlate with patients’ perception of hospital experience. J Trauma Acute Care Surg. 2017;82(4):722–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Kennedy GD, Tevis SE, Kent KC. Is there a relationship between patient satisfaction and favorable outcomes? Ann Surg. 2014;260(4):592–8; discussion 598-600.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Rice S. How a hospital’s Chief Experience Officer tackles barriers to better quality. Modern Healthcare; 2014.Google Scholar
  18. 18.
    Lyu H, Wick EC, Housman M, Freischlag JA, Makary MA. Patient satisfaction as a possible indicator of quality surgical care. JAMA Surg. 2013;148(4):362–367.CrossRefPubMedGoogle Scholar
  19. 19.
    Ma C, McHugh MD, Aiken LH. Organization of hospital nursing and 30-day readmissions in medicare patients undergoing surgery. Med Care. 2015;53(1):65–70.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Langley S. Effects of rounding on patient care. Nurs Stand. 2015;29(42):51–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Lake ET, Germack HD, Viscardi MK. Missed nursing care is linked to patient satisfaction: a cross-sectional study of US hospitals. BMJ Qual Saf. 2016;25(7):535–43.CrossRefPubMedGoogle Scholar
  22. 22.
    Stimpfel AW, Sloane DM, McHugh MD, Aiken LH. Hospitals known for nursing excellence associated with better hospital experience for patients. Health Serv Res. 2016;51(3):1120–34.CrossRefPubMedGoogle Scholar
  23. 23.
    Al-Abri R, Al-Balushi A. Patient satisfaction survey as a tool towards quality improvement. Oman Med J. 2014;29(1):3–7.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Schoenfelder T, Klewer J, Kugler J. Determinants of patient satisfaction: a study among 39 hospitals in an in-patient setting in Germany. Int J Qual Health Care. 2011;23(5):503–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290(12):1617–23.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987–93.CrossRefPubMedGoogle Scholar
  27. 27.
    Kane RL, Maciejewski M, Finch M. The relationship of patient satisfaction with care and clinical outcomes. Med Care. 1997;35(7):714–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Cowen ME, Czerwinski J, Kabara J, Blumenthal DU, Kheder S, Simmons S. The risk-outcome-experience triad: mortality risk and the hospital consumer assessment of healthcare providers and systems survey. J Hosp Med. 2016;11(9):628–35.CrossRefPubMedGoogle Scholar
  29. 29.
    Levin JM, Winkelman RD, Smith GA, et al. Impact of preoperative depression on hospital consumer assessment of healthcare providers and systems survey results in a lumbar fusion population. Spine (Phila Pa 1976). 2017;42(9):675–681.CrossRefGoogle Scholar
  30. 30.
    Deyo RA. Imaging idolatry: the uneasy intersection of patient satisfaction, quality of care, and overuse. Arch Intern Med. 2009;169(10):921–3.CrossRefPubMedGoogle Scholar
  31. 31.
    Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012;172(5):405-411.CrossRefPubMedGoogle Scholar
  32. 32.
    Biondi EA, Hall M, Leonard MS, Pirraglia PA, Alverson BK. Association between resource utilization and patient satisfaction at a tertiary care medical center. J Hosp Med. 2016;11(11):785–791.CrossRefPubMedGoogle Scholar
  33. 33.
    Chatterjee P, Joynt KE, Orav EJ, Jha AK. Patient experience in safety-net hospitals: implications for improving care and value-based purchasing. Arch Intern Med. 2012;172(16):1204–10.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Deborah R. Kaye
    • 1
  • Caroline R. Richardson
    • 2
    • 3
  • Zaojun Ye
    • 1
  • Lindsey A. Herrel
    • 1
    • 2
  • Chad Ellimoottil
    • 1
    • 2
  • David C. Miller
    • 1
    • 2
  1. 1.Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborUSA
  2. 2.Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborUSA
  3. 3.Department of Family MedicineUniversity of MichiganAnn ArborUSA

Personalised recommendations