San Diego, CA USA (UroToday.com) Many factors outside of patient demographics play an important role in radical prostatectomy (RP) outcomes. In this study, investigators sought to elucidate the impact of surgeon Board Certification on prostatectomy outcomes.
Using the SEER-Medicare database from 1992-2009, 26,704 men with complete data were analyzed who underwent radical prostatectomy. There were no median age differences between Non-Board Certified (NBC) surgeons and Board Certified (BC) surgeons, but there was a higher proportion of NBC surgeons in the ≥59 year category compared to BC surgeons. 23% of NBC surgeons were foreign-born compared to 12.3% in the BC surgeon group (p <0.001). NBC surgeons tended to have lower case-loads than BC surgeons in both open and minimally invasive RP approaches, with over 70% of NBC surgeons performing <8 cases per year. NBC surgeons were more likely to operate on patients with median household income of <$34,000 and less college education (p <0.001 and 0.003, respectively). Multivariable analysis showed increased odd ratios (range 1.33-2.02) for complications within 30 and 90 days, readmission within 90 days, and emergency department visits within 30 and 90 days for patients receiving RP from NBC surgeons. Additionally, NBC surgeons had greater rates of urinary complications (HR 1.47, p <0.001).
The authors found improved outcomes associated with board certification even when controlling for patient demographics and surgeon experience. Patients with a lower socioeconomic status were the main recipients of NBC RPs and underwent more complications. These findings expose a healthcare disparity that could be better addressed in the urological community.
Presented By: Daniel Rosen, MD
Written By: Blanca Morales, Department of Urology, University of California, Irvine at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA