Open Access

ARTICLE

Analysis of evidence within the AUA’s clinical practice guidelines

Samuel G. Antoine, Alexander C. Small, James M. McKiernan, Ojas Shah

Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
Address correspondence to Dr. Ojas Shah, Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Ave, 11th Floor, New York, NY 10032 USA

Canadian Journal of Urology 2018, 25(1), 9168-9178.

Abstract

Introduction: Surgical subspecialty societies release clinical practice guidelines (CPGs) to provide topic-specific recommendations to healthcare providers. We hypothesize that there may be significant differences in statement strength and evidence quality both within the American Urological Association (AUA) guidelines and compared to those published by the American Academy of Orthopedic Surgeons (AAOS) and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS).
Materials and methods: CPGs issued through 2017 were extracted from AUAnet.org. Statements were characterized by evidence basis, strength, and evidence quality. CPGs were compared among urologic subspecialties and to those from the AAOS and AAO-HNS. Analysis used Fisher’s exact tests and Student’s t-tests, with significance set at p < 0.05.
Results: A total of 25 AUA CPGs (672 statements) were reviewed, and 34.6% were non-evidence based, with the highest proportions in pediatrics (47.5%) and sexual medicine (46.5%). The AUA has published over twice as many statements as the AAOS and quadruple that of the AAO-HNS. A smaller proportion of AUA statements were evidence-based (65.4%) compared to the AAOS (80.5%, p < 0.001) and AAO-HNS (99.8%, p < 0.001), and fewer used "high" quality evidence (AUA 7.2% versus AAOS 21.2%, p < 0.001; versus AAO-HNS 16.1%, p < 0.001).
Conclusions: The AUA has published broad CPGs that far exceed those from the AAOS and AAO-HNS. The AUA has utilized extensive resources to provide guidance to help standardize care among urologists. In contrast, the AAOS and AAO-HNS may choose not to issue guidelines when evidence is limited. With the continued increase in high-quality clinical trials, the AUA will be able to further improve its comprehensive set of evidence-based CPGs.

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