Background Patient satisfaction has been increasingly emphasized, including the use of financial penalties for underperformance. However current measures of patient satisfaction do not address aspects specific to the care of surgical patients. We therefore aimed to examine the recently validated Surgical Care Survey (S-CAHPS) in order to determine which aspects of perioperative care are predictive of satisfaction with the surgeon. Methods All patients undergoing a general surgery operation at our institution over a 5 month period were sent a modified S-CAHPS within 3 days of discharge. Patients were then divided into two groups: those that rated their surgeon as the best possible and those giving a lower rating. Univariate and multivariate analyses were used to determine predictors of satisfaction with surgical care. S-CAHPS results were then compared with other satisfaction measures in a subset of patients. Results The response rate was 45.3% (456/1007). The average age was 59±16 years, length of stay was 4.1±6.6 days, and 23% had unscheduled operations. 72% of patients rated their surgeon as the best surgeon possible. On multivariate analysis, preoperative communication and attentiveness on the day of surgery were the most important determinants of overall surgeon rating. S-CAHPS scores correlated with other standard measures of satisfaction (HCAHPS scores). Conclusions S-CAHPS is a novel surgical satisfaction tool and is feasible to administer to patients undergoing general surgical procedures. Surgeon characteristics most predictive of high patient satisfaction are effective preoperative communication and attentiveness on the day of surgery.

Background Patient reported outcomes (PRO) have been increasingly emphasized; however determining clinically valuable PRO has been problematic and investigation limited. This study examines the association of a previously described PRO – readiness for discharge – with patient satisfaction and readmission. Study Design Data from adult patients admitted to our institution from 2009 to 2012 who completed both the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and the Press Ganey (PG) surveys post-discharge were extracted from an existing database of patients (comprised of 220 patients admitted for small bowel obstruction (SBO) and 98 patients with hospital stays ≥21 days). Using the survey question, “Did you feel ready for discharge?” (RFD), 2 groups were constructed, those RFD and those with lesser degrees of readiness (LRFD – less ready for discharge) using topbox methodology. Outcomes, readmission rates, and satisfaction were compared between those RFD and those LRFD. Results Three hundred and eighteen patients met the inclusion criteria; 45% were female and 94% were Caucasian. Median age was 62.3 years (interquartile range [IQR] 52.5-70.8 years). Median length of stay was 10 days (IQR 6.0-24.0 days) and 69.2% were admitted with SBO. The 30-day readmission rate was 14.3%; and 55% indicated they were RFD. Those RFD and LRFD had similar demographics, comorbidity scores, and rates of surgery. Those RFD had higher overall hospital satisfaction (87.3% RFD vs. 62.4% LRFD, p<0.001), higher physician communication scores (median 3.0 RFD vs 2.0 LRFD, p<0.001), and higher nursing communication scores (median 3.0 RFD vs. 2.0 LRFD, p<0.001). Readmission rates were similar between the groups (11.4% RFD vs 18.2% LRFD; p=0.09). Conclusions Readiness for discharge appears to be a clinically useful patient-reported metric, as those RFD have higher satisfaction with the hospital and physicians. Prospective investigation into variables affecting patient satisfaction in those LRFD is needed.

As a first step in developing a reliable and culturally sensitive instrument to assess depression in Korean-American youths, this community-based methodological study was designed to evaluate the characteristics of the DSM Scale for Depression (DSD). A total of 104 Korean Americans, 11 to 13 years, participated in this study, and the response patterns of this group were compared with Korean- (n = 20) and Anglo- (n = 557) American youths assessed by the Teen Life Changes Survey (TLCS). Overall, Korean-American youths showed significantly higher mental distress scores than Anglos. The DSD was found to be a culturally appropriate instrument for Korean Americans with good reliability (alpha =.92) and validity demonstrated by correlating with related constructs (loneliness, self-esteem, coping, social support, mastery, and somatic symptoms). The highest correlation coefficient was observed between depression and somatic symptoms (r =.61). These findings are informative for the design of further studies of mental health of Korean-American youths.

Background: Patient satisfaction is a patient-centered outcome of particular interest. Previous work has suggested that global measures of satisfaction may not adequately evaluate surgical care; therefore, the surgery-specific S-CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey was developed. It remains unclear how traditional outcome measures such as morbidity impact patient satisfaction. Our aim was to determine whether NSQIP-defined complications impacted satisfaction with the surgeon as measured by a surgery-specific survey, the S-CAHPS. Methods: All patients undergoing a general surgical operation from 6/13-11/13 were sent the S-CAHPS survey after discharge. Retrospective chart review was conducted using NSQIP variable definitions, and major complications were defined. Data were analyzed as a function of response to the overall surgeon-rating item, and those surgeons rated as the "best possible" or "topbox" were compared with those rated lower. Univariate and logistic regression were used to determine variable importance. Results: 529 patients responded, and 71.5% (378/529) rated the surgeon as topbox. The overall NSQIP complication rate was 14.2% (75/529) with 26.7% of those (20/75) being major complications. On univariate analysis, patients who rated their surgeon more highly were somewhat older (59 vs. 54yrs: p <0.001), more often underwent elective surgery (81% vs. 57%: p <0.001), and had an increased rate of operation for malignancy (31% vs. 17%). Neither the complication rate (total or major) nor the number of complications were associated with satisfaction scores. Conclusions: When examined on a patient-level with surgery-specific measures and outcomes, the presence of complications after an operation does not appear to be associated with overall patient satisfaction with surgeon care. This finding suggests that satisfaction may be an outcome distinct from traditional measures.

Introduction Increasing emphasis is being placed on appropriateness of care and avoidance of over- and under-treatment. Indeterminate thyroid nodules (ITN), present a particular risk for this problem because cancer found via diagnostic lobectomy (DL) often requires a completion thyroidectomy (CT). However, initial total thyroidectomy (TT) for benign ITN results in lifelong thyroid hormone replacement. We sought to measure the accuracy and factors associated with the extent of initial thyroidectomy for ITN. Methods We queried a single institution thyroid surgery database for all adult patients undergoing an initial operation for ITN. Multivariate logistic regression identified factors associated with either oncologic under- or over-treatment at initial operation. Results There were 639 patients with ITN. The median age was 52 (range 18 – 93), 78.4% were female, and final pathology revealed a cancer > 1 cm in 24.7%. The most common cytology was follicular neoplasm (45.1%) followed by Hurthle cell neoplasm (20.2%). CT or initial oncologic under-treatment was required in 58 patients (9.3%). Excluding those with goiters, 19.0% were treated with total thyroidectomy for benign final pathology. Multivariate analysis failed to identify any factor that independently predicted the need for CT. Female gender was associated with total thyroidectomy in benign disease (OR 2.1, 95% C.I. 1.0 – 4.5, p = 0.05). Age >45 predicted correct initial use of DL (OR 2.6, 95% C.I. 1.2 – 5.7, p = 0.02). Suspicious for PTC (OR 5.7, 95% C.I. 2.1 – 15.3, p<0.01) and frozen section (OR 9.7, 95% C.I. 2.5 – 38.6, p<0.01) were associated with oncologically appropriate initial TT. The highest frequency of CT occurred in patients with follicular lesion of undetermined significance (11.6%). Total thyroidectomy for benign final pathology occurred most frequently in patients with a Hurthle cell neoplasm (24.8%). Conclusions In patients with ITN, nearly 30% received an inappropriate extent of initial thyroidectomy from an oncologic standpoint. Tools to preoperatively identify both benign and malignant disease can assist in the complex decision-making to gauge the proper extent of initial surgery for ITN.