Cornea, Cataract and Refractive Surgery Management

Patient Satisfaction After Surgery

Research shows that patient satisfaction after surgery is related more to visual outcome and subjective improvement than clinical outcome. How many times have you seen a patient whose surgery went perfectly, and yet, they are upset with their results? A perfect surgical outcome does not guarantee a happy patient. This is particularly true in patients with a low level of health literacy, and the presence of systemic and ocular comorbidity.¹

One cross-sectional study evaluated 150 patients 50 years and older who had their first eye’s cataract surgery using a written questionnaire. Researchers found patient satisfaction with hospital care had a stronger correlation with overall satisfaction than patient satisfaction with the medical outcome (r=0.669 versus r=0.543, respectively).² They concluded satisfaction was more related to the patient's preoperative expectations and the quality of care given perioperatively.

A one year prospective follow-up study evaluated satisfaction using the Catquest-9SF-questionnaire, reporting the gain in visual function was significant in all nine dimensions (p<0.001, T test) and the mean item score improved from -0.54, (SD 1.5) at baseline to -3.1, (1.2) (p<0.001) at 12 months.³ Patients who reported better visual function at baseline with Catquest-9SF were more likely to be satisfied with treatment outcome at 12 months than those with greater baseline visual function impairment. The second-eye cataract surgery was performed in 87 of 131 (66%) patients within one year of the first. Additional procedures were performed within one year of the first eye, including YAG-laser capsulotomy (n=6), argon laser photocoagulation (n=5), vitrectomy (n=5) or other (n=8). Patients reported significantly less difficulty performing daily activities except for driving a car one year after surgery. Nineteen patients (15%) who were dissatisfied reported significantly more ocular symptoms (15/19, 79%) than those who were satisfied with their surgical outcomes. (44/112, 39%, p=0.001). The presence of postoperative ocular symptoms was related to lower patient satisfaction at 12 months after the first-eye cataract surgery.

Here are pearls to take away:
• Educate patients regarding the most likely outcome for unaided vision and best-corrected before surgery.
• Educate patients on comorbidities that might limit results such as macular degeneration, corneal disease and glaucoma.
• Address patient concerns at each visit postoperatively.
• Discuss the need for additional procedures early in postoperative care.