Board certification status and surgical outcomes after uniportal video-assisted thoracoscopic anatomical pulmonary resection: a nationwide multicenter analysis.

Abstract

Objective: Uniportal video-assisted thoracoscopic surgery (U-VATS) has gained widespread acceptance for anatomical pulmonary resection. However, concerns remain regarding its safety when performed by surgeons at an early stage of their surgical career. Evidence linking surgeon-related factors to perioperative outcomes remains limited. We examined the association between board certification status and perioperative outcomes using a nationwide multicenter U-VATS registry in Japan.

Methods: This multicenter retrospective cohort study used a nationwide U-VATS registry involving 43 institutions. Patients with primary lung cancer who underwent U-VATS lobectomy or segmentectomy between April 2018 and March 2023 were included. The primary outcome was surgical procedure-related complications. Propensity score matching and mixed-effects logistic regression with institutional random effects were applied.

Results: A total of 3532 patients were included, yielding 357 matched pairs. Surgical procedure-related complications occurred in 14.6% of the non-board-certified group and 11.2% of the board-certified group, with no statistically significant difference (OR 1.37, 95% CI 0.86-2.19; p = 0.183). No statistically significant differences were observed in conversion to thoracotomy, additional port placement, operative time, readmission, or mortality between the groups. Postoperative drainage duration and hospital stay were shorter in the non-board-certified group.

Conclusions: Board certification status was not associated with surgical procedure-related complications after U-VATS. These findings may support the implementation of U-VATS by non-board-certified surgeons within structured training systems and with appropriate intraoperative support.