Iyan Younus1, Mina M Gerges1, Rafael Uribe-Cardenas1, Peter Morgenstern1, Ashutosh Kacker2, Abtin Tabaee2, Vijay K Anand2, Theodore H Schwartz3,4,5,6. 1. Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA. 2. Department of Otolaryngology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA. 3. Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA. schwarh@med.cornell.edu. 4. Department of Otolaryngology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA. schwarh@med.cornell.edu. 5. Department of Neuroscience, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA. schwarh@med.cornell.edu. 6. Departments of Neurosurgery, Otolaryngology and Neuroscience, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th St. Box #99, New York, NY, USA. schwarh@med.cornell.edu.
Abstract
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.
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.
Authors: Laura Van Gerven; Zhen Qian; Anastasiya Starovoyt; Mark Jorissen; Jeroen Meulemans; Johannes van Loon; Steven De Vleeschouwer; Julie Lambert; Marie Bex; Vincent Vander Poorten Journal: Front Oncol Date: 2021-05-07 Impact factor: 6.244
Authors: Julien Boetto; Irina Joitescu; Isabelle Raingeard; Sam Ng; Marine Le Corre; Nicolas Lonjon; Louis Crampette; Valentin Favier Journal: Front Surg Date: 2022-08-02
Authors: Jai Deep Thakur; Alex Corlin; Regin Jay Mallari; Samantha Yawitz; Amalia Eisenberg; Walavan Sivakumar; Chester Griffiths; Ricardo L Carrau; Sarah Rettinger; Pejman Cohan; Howard Krauss; Katherine A Araque; Garni Barkhoudarian; Daniel F Kelly Journal: Pituitary Date: 2021-07-02 Impact factor: 4.107