BACKGROUND : The current study aimed to define the relationship between patient satisfaction, hospital-level factors, and clinical outcomes among patients undergoing major surgery for cancer.

METHODS : The Medicare Inpatient Standard Analytic Files were used to identify patients undergoing lung, esophageal, colorectal, hepatic, or pancreatic surgery between 2016 and 2017, and Hospital Consumer Assessment of Healthcare Providers and Systems survey data were used to assess performance in terms of patient satisfaction.

RESULTS : Among 60,446 patients, half were female (n = 31,244, 52%) with a median age of 73 years (interquartile range [IQR] 69-78 years). Patients who underwent surgery for esophageal resection (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.10-5.40) and were Caucasian (OR 2.43; 95% CI 2.11-2.81) had optimal patient satisfaction. Hospital level factors such as urban location (OR 3.69; 95% CI 3.16-4.29), 200 + beds (OR 3.58; 95% CI 3.09-4.13), greater inpatient surgical volume (OR 3.03; 95% CI 2.82-3.25), higher nurse-to-bed ratio (OR 4.57; 95% CI 4.25-4.92), non-profit hospital status (OR 1.14; 95% CI 1.01-1.29), and non-teaching hospital status (OR 1.52; 95% CI 1.39-1.65) were related to optimal patient satisfaction. In adjusted analysis, patients undergoing surgery at hospitals reporting poor or average patient satisfaction had 22% higher odds of 90-day mortality than patients undergoing surgery at optimal-satisfaction hospitals (OR 1.22; 95% CI 1.09-1.36). In addition, hospitals with the highest patient satisfaction scores also had the highest proportion of surgical cases that achieved the composite textbook outcome (TO) quality metric (OR 1.12; 95% CI 1.05-1.20).

CONCLUSION : Higher patient satisfaction was strongly associated with hospital structural measures such as bed number, urban location, nurse-to-bed ratio, and "optimal" TO after cancer surgery. These data highlight how high quality of care can directly lead to improved patient satisfaction among surgical patients with cancer.