Patients with higher postoperative pain after ambulatory shoulder surgery reported lower satisfaction: a prospective observational study

Background: Due to the Affordable Care Act passed in 2010, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys have become a mandatory part of performance reporting. As the Center for Medicaid and Medicare Services (CMS) plans to extend their assessment of patient care from Clinician and Group (CG-CAHPS) to Outpatient Ambulatory Surgery (OAS-CAHPS), it becomes important to understand these two scores and their determinants. The purpose of this study was to evaluate satisfaction scores according to the CG-CAHPS and OAS-CAHPS surveys after outpatient shoulder surgery and their associated factors. Methods: This prospective observational study included 75 patients who underwent outpatient shoulder surgery by the senior author between August 2019 and March 2020. Patients were asked to fill out demographic information and the following combination of surveys pre-operatively to assess their expectations for the surgery: Pain Catastrophizing Scale (PCS), short form-12 (SF-12), resilience scale (RS11), PROMIS Upper Extremity (PROMIS UE), and Shoulder surgery Expectation Survey (SSES). After surgery, patients were contacted to evaluate their satisfaction levels using the CG-CAHPS and OAS-CAHPS surveys. Results: The average CG-CAHPS score was 91.3 +/- 11.0 (range, 42.1-100) and the average OAS-CAHPS score was 93.4 +/- 6.2 (range, 69.1-100) while respective average top-box scores were 71.6 +/- 19.2 (range, 14.1-95.8) and 80.3 +/- 12.0 (range, 29.2-95.8). There were no significant differences in pre-operative SF-12, PCS, RS-11, and SSES between satisfied and unsatisfied CG-CAHPS or OAS-CAHPS groups, however, patients with higher OAS-CAHPS scores had higher PROMIS UE scores (P=0.05, regression coefficient of 0.11). Multivariable regression analysis demonstrated Visual Analog Scale (VAS) pain score at discharge had a statistically significant relationship with lower CG-CAHPS (P=0.05, regression coefficient of -10.3) and OAS-CAHP scores (P=0.008, regression coefficient of -7.97). Conclusions: Patients who had higher VAS scores for pain at time of discharge report lower levels of clinician (CG-CAHPS) and ambulatory surgery center (OAS-CAHPS) satisfaction after outpatient shoulder surgery. Overall, patient CAHPS satisfaction seems to be dependent on postoperative pain levels and access