The Impact of American Board of Urology Certification on Post-operative Outcomes for Patients: Assessing National Trends

Abstract

Objective: To examine a large national sample of surgeons to determine if American Board of Urology (ABU) certification status correlated with improved post-operative outcomes for certain procedures in urologic oncology.

Methods: We performed a retrospective cohort study of all patients aged 65 and over having radical prostatectomy (RP), radical cystectomy (RC), and radical or partial nephrectomy (RPN) from 2015 to 2021 using the Medicare database. Our main exposure was ABU certification of the surgeon at the time of the index procedure. Primary outcomes were 90-day mortality, 30-day unplanned readmission, need for blood transfusion, and hospital length of stay (LOS). We used multivariable linear and logistic regression adjusted for multiple covariates including surgeon, hospital, and patient characteristics.

Results: We identified 150,037 patients who had one of the four index operations between 2015 and 2021. This included 62,193 RP, 19,256 RC, and 69,314 RPN. Twenty-two percent of all procedures were performed by non-ABU certified surgeons: 24% RP, 22% RC, and 20% RPN. On multivariable stepwise regression adjusting for all relevant confounding covariates, ABU status was protective for several procedure-specific outcomes. Specifically, procedures performed by ABU certified surgeons had a lower LOS (P <.01 for RP, RC, and RPN) and lower odds of a blood transfusion.

Conclusion: In a large national sample, ABU certification was associated with lower LOS and lower likelihood of a blood transfusion after RP, RC, and RPN. This study helps to define important post-surgical quality indicators associated with the board certification process in urology.