The slope of the learning curve in 600 consecutive endoscopic transsphenoidal pituitary surgeries.
Adenoma
/ surgery
Adult
Aged
Cerebrospinal Fluid Leak
/ epidemiology
Drainage
Endoscopy
/ methods
Female
Humans
Learning Curve
Male
Middle Aged
Nasal Cavity
/ surgery
Neurosurgical Procedures
/ methods
Pituitary Neoplasms
/ surgery
Postoperative Complications
/ surgery
Retrospective Studies
Sphenoid Bone
/ surgery
Treatment Outcome
Complication
Endonasal
Endoscopic
Follow-up
Gross total resection
Learning curve
Outcomes
Surgery
Tail end
Transsphenoidal
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
18
04
2020
accepted:
19
06
2020
pubmed:
2
7
2020
medline:
16
3
2021
entrez:
2
7
2020
Statut:
ppublish
Résumé
Endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma has become a mainstay of treatment over the last two decades and it is generally accepted that once this learning curve is achieved, a plateau is reached with little incremental improvement. The objective of this study was to assess the slope of the learning curve over a long period of time for a variety of outcomes measures. We examined outcomes and complications in a consecutive series of 600 EETS for pituitary adenoma grouped into quartiles based on date of surgery. GTR significantly increased across quartiles from 55 to 79% in the last quartile (p < 0.005). The rate of intraoperative CSF leak significantly decreased from 60% in the first quartile to 33% in the last quartile and the rate of lumbar drain placement from 28% in the first quartile to 6% in the last quartile (p < 0.005). Hormonal remission for secreting adenomas increased from 68% in the first quartile to 90% in the last quartile (p < 0.05). The rate of post-operative CSF leak trended lower (3% in first quartile to 0.7% in last two quartiles). The greatest improvement in outcome occurred between the first and second quartiles (19.9%), but persistent improvement occurred between the second and third (6.7%) and third and fourth quartiles (8.0%). Although the slope of the learning curve is steeper earlier in a surgeon's experience, the slope does not plateau and continues to increase even over more than a decade.
Sections du résumé
BACKGROUND
Endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma has become a mainstay of treatment over the last two decades and it is generally accepted that once this learning curve is achieved, a plateau is reached with little incremental improvement.
OBJECTIVE
The objective of this study was to assess the slope of the learning curve over a long period of time for a variety of outcomes measures.
METHODS
We examined outcomes and complications in a consecutive series of 600 EETS for pituitary adenoma grouped into quartiles based on date of surgery.
RESULTS
GTR significantly increased across quartiles from 55 to 79% in the last quartile (p < 0.005). The rate of intraoperative CSF leak significantly decreased from 60% in the first quartile to 33% in the last quartile and the rate of lumbar drain placement from 28% in the first quartile to 6% in the last quartile (p < 0.005). Hormonal remission for secreting adenomas increased from 68% in the first quartile to 90% in the last quartile (p < 0.05). The rate of post-operative CSF leak trended lower (3% in first quartile to 0.7% in last two quartiles). The greatest improvement in outcome occurred between the first and second quartiles (19.9%), but persistent improvement occurred between the second and third (6.7%) and third and fourth quartiles (8.0%).
CONCLUSION
Although the slope of the learning curve is steeper earlier in a surgeon's experience, the slope does not plateau and continues to increase even over more than a decade.
Identifiants
pubmed: 32607745
doi: 10.1007/s00701-020-04471-x
pii: 10.1007/s00701-020-04471-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM