Kung Justin E, Zhang Tina, Aneizi Ali, Koenig Scott, Shasti Keyan, Wahl Alexander J, Packer Jonathan D, Meredith Sean J, Henn R Frank
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
J Clin Orthop Trauma. 2021 Jun 27;20:101486. doi: 10.1016/j.jcot.2021.101486. eCollection 2021 Sep.
Patient satisfaction metrics are increasingly being utilized as tools to evaluate the quality of healthcare and affect reimbursements. The objectives of this study were to (1) identify factors associated with two-year patient satisfaction after elective knee surgery, (2) compare the Surgical Satisfaction Questionnaire-8 (SSQ-8) and a numeric satisfaction scale (NSS), and (3) determine if two-year patient satisfaction can be predicted based on preoperative factors.
A total of 365 patients undergoing elective knee surgery at a single center were administered questionnaires to assess demographics, medical history, and various patient-reported outcomes preoperatively and at two years postoperatively. Patient satisfaction was measured at two years postoperatively with SSQ-8 and NSS. Bivariate and multivariate statistical analyses were performed to identify significant associations and independent predictors of satisfaction.
SSQ-8 and NSS scores were significantly correlated (r = 0.68, < 0.0001). Lower SSQ-8 and NSS scores were associated with black race, higher BMI, more comorbidities, unemployment, smoking, higher ASA score, and greater Met Expectations ( < 0.05). Better scores on patient-based outcome measures and better improvement from baseline were significantly correlated with higher satisfaction on both SSQ-8 and NSS. Multivariable analysis identified greater Met Expectations and higher two-year Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scores as independent predictors of greater SSQ-8 scores (adjusted r = .52). Greater Met Expectations and better two-year PROMIS Social Satisfaction scores were independent predictors of NSS score (adjusted r = .41). In contrast, when only preoperative variables were considered, the multivariable regression model accounted for only 14% of the variance in SSQ-8 and 6% of the variance in NSS.
While there are multiple preoperative factors that are associated with two-year patient satisfaction after knee surgery, those factors contribute relatively little to satisfaction. Meeting expectations and better patient-based outcomes at two years are more important.
患者满意度指标越来越多地被用作评估医疗质量和影响报销的工具。本研究的目的是：（1）确定与择期膝关节手术后两年患者满意度相关的因素；（2）比较手术满意度问卷-8（SSQ-8）和数字满意度量表（NSS）；（3）基于术前因素确定是否可以预测两年患者满意度。
在单一中心，共365例行择期膝关节手术的患者在术前和术后两年接受问卷调查，以评估人口统计学、病史和各种患者报告的结局。术后两年用SSQ-8和NSS测量患者满意度。进行双变量和多变量统计分析以确定满意度的显著关联和独立预测因素。
SSQ-8和NSS评分显著相关（r = 0.68，P < 0.0001）。较低的SSQ-8和NSS评分与黑人种族、较高的体重指数、更多的合并症、失业、吸烟、较高的美国麻醉医师协会（ASA）评分以及更高的“符合预期”相关（P < 0.05）。基于患者的结局指标得分更高以及与基线相比改善更好与SSQ-8和NSS上更高的满意度显著相关。多变量分析确定更高的“符合预期”以及更高的两年患者报告结局测量信息系统（PROMIS）疼痛干扰评分是更高SSQ-8评分的独立预测因素（调整r = 0.52）。更高的“符合预期”以及更好的两年PROMIS社会满意度评分是NSS评分的独立预测因素（调整r = 0.41）。相比之下，仅考虑术前变量时，多变量回归模型仅解释了SSQ-8中14%的方差和NSS中6%的方差。
虽然有多个术前因素与膝关节手术后两年患者满意度相关，但这些因素对满意度的贡献相对较小。两年时达到预期和更好的基于患者的结局更为重要。
