Outcome Squares Integrating Efficacy and Safety, as Applied to Functioning Pituitary Adenoma Surgery

The Journal of Clinical Endocrinology & Metabolism, vol. 106, pp. e3300–e3311

Abstract

CONTEXT: Transsphenoidal surgery is standard care in the treatment of hormone-secreting pituitary adenomas. Current clinician-reported surgical outcome measures are one-dimensional, typically focusing primarily on complete or partial resection, and secondarily on complication rates. However, outcomes are best reflected by the delicate balance of efficacy and complications at patient level. OBJECTIVE: This study proposes a novel way to classify and report outcomes, integrating efficacy and safety at the patient level. METHODS: Retrospective chart review of all pure endoscopic transsphenoidal surgical procedures for acromegaly, Cushing's disease, and prolactinoma between 2010 and 2018 in a single tertiary referral center. We present our results in a classic (remission and complications separate) and in a novel outcome square integrating both outcomes, focusing on intended and adverse effects (long-term complications). This resulted in 4 outcome groups, ranging from good to poor. We use this approach to present these outcomes for several subgroups. RESULTS: A total of 198 surgical procedures were included (44 reoperations). Remission was achieved in 127 operations (64%). Good outcome was observed after 121 (61%), and poor outcome after 6 (3%) operations. When intended effect of surgery was applied (instead of remission), good outcome as intended was achieved after 148 of 198 surgeries (75%) and poor outcome after 4 (2%). CONCLUSION: Quality of a surgical intervention can be presented in 4 simple categories, integrating both efficacy and safety with flexibility to adapt to the individualized situation at patient, disease, and surgical strategy and to the outcome of interest.

Authors 10

1. Friso de Vries corresponding Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Medicine Division of Endocrinology, Leiden University Medical Center

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

   Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, ZA Leiden, The Netherlands

2. Daniel J. Lobatto Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Neurosurgery, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

   Department of Neurosurgery, Leiden University Medical Centre, ZA Leiden, The Netherlands

3. Marco J. T. Verstegen Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Neurosurgery, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

   Department of Neurosurgery, Leiden University Medical Centre, ZA Leiden, The Netherlands

4. Pieter J. Schutte Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Neurosurgery, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

   Department of Neurosurgery, Leiden University Medical Centre, ZA Leiden, The Netherlands

5. Irene C. Notting Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Ophthalmology, Leiden University Medical Centre (LUMC)

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

   Department of Ophthalmology, Leiden University Medical Centre, ZA Leiden, The Netherlands

6. Mark C. Kruit Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Radiology, Leiden University Medical Center

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

   Department of Radiology, Leiden University Medical Centre, ZA Leiden, The Netherlands

7. S. Faisal Ahmed Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Medicine Division of Endocrinology, Leiden University Medical Center

   Leiden University · Leiden University Medical Center · Royal Hospital for Children · Queen Elizabeth University Hospital · University of Glasgow

   Affiliation as printed

   Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

   Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, ZA Leiden, The Netherlands

   Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow and Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK

8. Alberto M. Pereira Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Medicine Division of Endocrinology, Leiden University Medical Center

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

   Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, ZA Leiden, The Netherlands

9. Wouter R. van Furth Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Neurosurgery, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

   Department of Neurosurgery, Leiden University Medical Centre, ZA Leiden, The Netherlands

10. Nienke Ruurdje Biermasz Aachen Centre for Endocrine Tumours Leiden (CETL) Department of Medicine Division of Endocrinology, Leiden University Medical Center

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands

    Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, ZA Leiden, The Netherlands