Visualizing the US News & World Report Prostate Cancer Surgery Rating: Developing a Coherent Cohort

Hospital quality leaders and clinicians in urology receive conflicting signals from hospital rankings, such as the US News & World Report (USNWR), which reports prostatectomy patients to target for quality improvement. Our objective was to develop a clinically coherent cohort definition for radical prostatectomy spanning inpatient and outpatient settings and to assess overlap with USNWR prostate cancer surgery cohorts. This is a cross-sectional, multisite study of all consecutive radical prostatectomies performed within a large, integrated US health system in 2024.

We created an institutional definition of prostate cancer surgery inclusive of inpatient and outpatient procedures across all payers, requiring an ICD (International Classification of Diseases)-10 diagnosis code for prostate cancer (C61) plus a procedural code for radical prostatectomy (Common Procedural Terminology 55810, 55812, 55815, 55840, 55842, 55845, or 55866, or ICD-10 procedure codes with clinical confirmation). We then reconstructed the 3 USNWR prostate cancer surgery cohorts: (1) outpatient volume, (2) outpatient potentially preventable complications, and (3) inpatient measures. Our main outcome was percent agreement between the institutional prostatectomy cohort and each USNWR comparator cohort.

Only 716/1591 (45%) radical prostatectomies performed at our institution were captured in at least 1 USNWR definition, 613/1591 (39%) were captured by the USNWR potentially preventable outpatient complications definition, and 97 (6.1%) were captured by the inpatient outcomes definition.

USNWR prostatectomy cohorts capture less than half of clinically relevant cases. More inclusive, clinically coherent definitions-such as our institutional cohort-are needed to reliably benchmark hospital performance in radical prostatectomy.