Unsolicited Patient Complaints in Spine Surgery: An In-Depth Study of How and Why They Occur

The high-risk yet elective nature of spine surgery can often lead to patient complaints. Examining these complaints can improve care quality and experience. This multi-institutional study analyzed unsolicited patient complaints (UPCs) in spine surgery to: (1) compare mean complaints among spine surgeons, other surgeons, and nonsurgeon physicians; (2) categorize patient complaints; and (3) assess whether complaints were linked to surgeon-patient interactions.

A multi-institutional cross-sectional study across 200 hospitals (2014-2017) analyzed deidentified UPCs regarding neurosurgery/orthopedic spine teams, categorizing complaints as surgeon- or nonsurgeon-related, focusing on communication, professionalism, complications, and hospital infrastructure. Descriptive and bivariate statistics were performed.

Of 42 380 physicians, 525 were spine surgeons, averaging 7.2 ± 8.3 UPCs, significantly higher (P < .001) than nonspine surgeons (5.6 ± 6.3) and nonsurgeons (3.3 ± 5.4). Of 149 UPCs, 43% met multiple categories, 42% were not directly related to surgeon-patient interactions, and 58% occurred preoperatively. Reasons for complaints were as follows: Communication (64%): 63.2% stemmed from lack of communication rather than poor communication (36.8%). Attending surgeons accounted for 70.5% of communication issues. Lack of empathy was reported in 10.1%. Professionalism (26%): 86.8% were attributed to the attending surgeon. Postoperative complications (24%): Permanent deficits (4%) and dissatisfaction with outcomes (28.9%) were reported. Hospital infrastructure (14%): Cost/insurance-related issues (4.0%) were reported. People not offered surgery (12%): Reasons included the following: infrastructure/personnel (33.3%), risks-outweighing-benefits (27.8%), patient-related health reasons (11.1%), and perceived discrimination (5.6%). Clinic issues (12%): Dissatisfaction with not being seen by the surgeon (5.4%), long waiting times (6.0%), and appointment without previous imaging (1.3%) were reported.

Among spine surgeons, 42% of complaints were unrelated to direct surgeon-patient interactions, and 58% occurred before any surgery was performed. Communication (64%) was the most common issue, with 70% being surgeon-related. Nonsurgeon-related complaints involved hospital infrastructure, not offering surgery, seeing advanced practice providers, and clinic inefficiencies. A collaborative effort of the healthcare team is crucial to address systemic issues and enhance care quality.