Recommending Surgery Increases Patient Satisfaction with Arthroplasty Surgeons.

Background: Current guidelines recommend shared decision-making in the treatment of hip and knee osteoarthritis, but the impact of individual treatment decisions on patient satisfaction scores is unknown. We hypothesized that clinic Press Ganey satisfaction ratings would be higher for patients who later underwent arthroplasty than patients who did not have surgery.

Methods: Press Ganey satisfaction surveys were obtained from all patient visits at a single academic institution's arthroplasty clinic from 2010 to 2018. We identified those patients who went on to have a total joint arthroplasty after shared decision-making. Among 1,133 patients who filled out a Press Ganey survey, 559 (49%) patients underwent surgery, and 574 (51%) patients did not. We then compared differences in provider 5-star ratings and mean star ratings between patients who did or did not have surgery using Chi-square, logistic regression, and t-tests.

Results: Patients who had surgery were more likely to give a 5-star rating (75 versus 70%, P = 0.001) and had 62% higher odds of giving a 5-star rating for the likelihood to recommend the provider (odds ratio: 1.62, 95% confidence interval: 1.19 to 2.19, P = 0.001). Each provider received a higher mean star rating from patients who underwent arthroplasty (4.66 ± 0.67) when compared to those who did not receive surgery (4.57 ± 0.80, P = 0.001). Providers who had a higher percentage of their patients receive surgery also had higher overall mean star ratings (P = 0.001).

Conclusion: Press Ganey satisfaction scores may be influenced by the decision to pursue operative treatment for hip and knee arthritis. Providers who do not recommend surgery may receive lower satisfaction scores, despite using a shared decision-making approach. Patient satisfaction, therefore, may not be a valid proxy for quality of care in arthroplasty and must be questioned as a quality or reimbursement metric.