The Impact of Preoperative Depression on Hospital Consumer Assessment of Healthcare Providers and Systems Survey Results in a Cervical Spine Surgery Setting

Study Design.Retrospective cohort study using prospectively collected data.Objective.The aim of this study was to determine the association between preoperative depression and patient experience in a cervical spine surgery population.Summary of Background Data.The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is used to measure patient experience and its scores directly influence reimbursement in the United States. Although it is well-established in the literature that untreated depression is associated with worse patient-reported outcomes in cervical spine surgery, no previous studies have analyzed the association between depression and patient satisfaction for these patients.Methods.HCAHPS survey responses from patients undergoing cervical spine surgery between 2013 and 2015 were collected at a tertiary care center. HCHAPS survey responses were linked to demographic data as well as patient-reported quality of life (QOL) metrics including Patient Health Questionnaire, EuroQol 5 Dimensions index, and Visual Analog Scale for neck pain for each patient. Preoperative PHQ-9 scores of >= 10 (moderate to severe depression) was used to define preoperative depression. Uni- and multivariable analyses were performed to investigate the association of preoperative depression and top-box scores on several dimensions on the HCAHPS survey.Results.In our 145-patient cohort, depressed patients were on average younger, had higher preoperative neck pain scores, and had a lower health-related QOL. Depressed patients were less likely to report satisfaction with questions related to doctor respect (P=0.020) and doctors listening (P=0.030). After adjusting for covariates, multivariable logistic regression analysis revealed that patients with preoperative depression had lower odds of feeling respected by their physicians (odds ratio=0.14, 95% confidence interval: 0.02-0.87, P=0.035).Conclusion.In patients undergoing cervical spine surgery, preoperative depression was found to have a negative association with patient perceptions of doctor communication as measured by the HCAHPS survey. These results highlight depression as a risk factor for worse patient experience communicating with their spine surgeon.Level of Evidence: 3