Establishing survey methodology to capture long term population level patient reported outcomes (PROs) in a surgical population

Understanding long-term patient outcomes (PROs) following surgery requires an efficacious survey methodology. Leveraging a statewide hernia surgery registry to establish a sampling frame, we conducted a 1-year post-operative survey using measures of patient-reported hernia recurrence (the Ventral Hernia Recurrence Inventory), pain (the PROMIS Pain Intensity 3a), and quality of life (the HerQLes scale). Our responsive design approach varied invitation and reminder contact modes and incentive offer across multiple design phases, with the goal of minimizing non-response bias and maximizing cost effectiveness. Outcomes included: contact and response rates (%); item non-response (%); and the association between reminders and incentive offer with response rates, respondent characteristics, and item non-response (%). Differences in demographic and clinical characteristics of respondents and non-respondents were investigated and adjusted using registry data. Of 7062 patients who received hernia surgery between January 2020 and March 2022, 6068 were sampled, 5645 were contacted (contact rate 93.0%), and 1816 responded to the survey (overall response rate 29.9%). Response rates by cohort were 42.3%, 32.5%, 25.2%, and 25.9%, with overall low item non-response. Response rates increased with number of reminders, but with diminishing returns over time; offer of postpaid incentive over no incentive did not significantly improve response rates or influence item non-response. Weighted respondents were comparable to the survey population. We illustrate a strategy to maximize response rate amongst surgical patients and evaluate the representativeness of long-term PROs using a sample-based registry, targeted multi-mode contact methods, and weighting adjustment methods.