results was the possibility of selection bias by which patients
actually completed the HCAHPS survey. The authors note
that 237 patients completed the survey, but the authors do
not provide a “response rate” for the survey; if it is low, then
there is a possibility that the survey results can be skewed
based on external influences. Additionally, although only “top
box” analysis of HCAHPS responses is a common method of
reporting and analysis, it might have been helpful to study
the distribution of mediocre and poor results as well to better
understand the total spectrum of results.
In summary, this study demonstrates that approximately
a quarter of the lumbar fusion surgery patients studied were
moderately or severely depressed and that depression was an
independent predictor of lower HCAHPS scores. The implica-
tions of these finding are that interpretation of HCHAPS scores
may need to be adjusted for variables such as depression and/
or that increased emphasis on addressing such preoperative
depression needs to be further emphasized. The importance
of accounting for patient satisfaction is increasingly taken
into account, and research such as that of Levin et al is vital
to a better understanding and response to results of surveys
such as HCHAPS.
A Hilibrand: nothing to disclose.
J Grauer: Consulting: Stryker (D), Medtronic ($0), Bioventus (B).
Other Office: NASS (Nonfinancial, Program Committee Co-chair,
2017); LSRS (Nonfinancial, Program Committee Co-chair. 2016,
2017); Other: Legal consulting (Legal reviews over the past year).