Does reduction of length of hospital stay in surgery influence patient satisfaction ratings? results of a regional study in Germany

Background: Concerns about the impact of shorter length of stay due to the introduction of the Diagnosis Related Groups in Germany in 2003 has garnered increased attention from clinicians, patients, and health politicians. The average hospital stay of surgical patients has been reduced from 8.5 days in 2002 to 6.7 days in 2011. While several national studies on the impact of the DRG on costs and medical outcomes have been conducted, yielding inconsistent results, the impact of reduced length of stay on subjective patient assessments has not been examined yet. Methods: The study sample included 4.162 surgical patients from 55 German hospitals who responded to a validated survey that was administered after discharge in 2012. The questionnaire assessed satisfaction with medical and service aspects on a six-point ordinal rating from excellent (6) to very poor (1). The survey also collected information about the actual length of stay in days (1-2, 3-7, 8-14, >14) and asked the patients to evaluate their length of stay (‘too short', ‘too long', ‘just right', ‘don't know'). The Kruskal Wallis test and Mann-Whitney-U test were used to determine whether patient satisfaction scores differed according to length of stay and according to perceived length of stay. All associations were considered to be statistically significant at p<0.05-level. Results: In total, 75% of the patients perceived their stay as appropriate, about 9.7% felt their stay was too short, 3.3% too long, and 12% could not decide. Overall satisfaction scores and patients' willingness to return to the provider were significantly higher for patients who felt their stay was just right (grouped median: 5.29; willingness to return: 91%) and were lower among patients who perceived their stay to be too short or too long. Patients perceiving their hospital stay as too long were significantly less satisfied and less likely to return than patients perceiving their hospital stay as too short (4.59; 62.8% vs. 4.90; 76.2%, p<0.05). In contrast, differences in satisfaction scores according to the objective length of stay measured in days were much smaller and did not remain statistically significant. Conclusion: Patient satisfaction did not differ regarding the time spent in hospital which implies that the reduction of length of stay does not significantly affect patients' perceptions of quality of care and services. However, patients' subjective perceptions of the appropriateness of length of stay are important for patient satisfaction. Study findings indicate that patients prefer shorter hospital stays.