低风险库欣病患者初级内镜鼻内手术的结局指标:来自垂体腺瘤及相关疾病联盟登记的循证立场声明

IF 3.6 2区 医学 Q1 CLINICAL NEUROLOGY
Michael Karsy, Varun R Kshettry, James J Evans, Garni Barkhoudarian, Won Kim, Donato R Pacione, Paul A Gardner, Juan C Fernandez-Miranda, Carolina G Benjamin, Michael P Catalino, Gabriel Zada, Robert C Rennert, Julie M Silverstein, Kyle Wu, Jamie J Van Gompel, Michael R Chicoine, Andrew S Little
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引用次数: 0

摘要

目的:关于库欣病手术结果的报道大多局限于专家外科医生的单中心经验。因此,对于内窥镜鼻内库欣病手术,没有可用于指导质量改进工作的通用手术结果指标。考虑到未达到缓解的患者的高发病率和高死亡率,这是一个潜在的问题。本研究提出了一套针对低风险库欣病患者的循证指标,这些患者有望获得最佳结果,重点关注美国垂体中心多中心合作的护理成本效率和手术结果。方法:垂体腺瘤及相关疾病登记处(RAPID)联盟指导委员会根据美国12个垂体中心的现有数据提出了这些指标。确定了接受首次手术的低风险患者的基准人群。患者特征和结果由数据协调中心汇总和分析。使用两种方法报告指标。结果:从2006年1月1日至2022年12月31日,共有来自12个中心的431例患者接受了初级经蝶腔内窥镜手术。低危队列227例患者(年龄< 70岁,BMI < 50,微腺瘤,Knosp分级0-2)。对于成本效益指标,平均(SD)住院时间为3.8(4.8)个午夜,再次入院的患者比例为11.1%。安置到专业护理机构的比率为2.2%。手术结果方面,术后脑脊液漏率为1.3%,1年持续手术缓解率为81.2%。永久性和暂时性精氨酸抗利尿激素缺乏率分别为1.8%和11.9%。中心的第75百分位表现为住院时间为3.0个午夜,90天计划外再入院为6.3%,处理到熟练护理机构的< 1%,脑脊液渗漏< 1%,1年持续缓解为92.2%。永久性和暂时性精氨酸抗利尿激素缺乏症的第75百分位数均< 1%。结论:在首次接受垂体内窥镜手术的低风险库欣病患者人群中,提出了一套基于证据的指标。外科医生可以使用这些指标来评估和提高其临床路径的质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcome metrics for primary endoscopic endonasal surgery for low-risk patients with Cushing's disease: an evidence-based position statement from the Registry of Adenomas of the Pituitary and Related Disorders consortium.

Objective: Reports of surgical outcomes for Cushing's disease are mostly limited to single-center experiences by expert surgeons. Therefore, no generalizable surgical outcome metrics for endoscopic endonasal Cushing's disease surgery are available for practitioners to guide quality-improvement efforts. This is potentially problematic, given the high morbidity and excess mortality observed in patients who do not achieve remission. This study proposes a bundle of evidence-based metrics for low-risk patients with Cushing's disease, for whom optimal outcomes would be expected, that focus on the cost efficiency of care and surgical outcomes from multicenter collaboration of US pituitary centers.

Methods: The steering committee of the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) consortium proposed the metrics based on available data from 12 US pituitary centers. A benchmarking population of low-risk patients undergoing first-time surgery was identified. Patient characteristics and outcomes were aggregated and analyzed by a data coordinating center. Metrics were reported using 2 approaches.

Results: A total of 431 patients from 12 centers who underwent primary endoscopic transsphenoidal surgery from January 1, 2006, to December 31, 2022, were included. There were 227 patients in the low-risk cohort (age < 70 years, BMI < 50, microadenoma, and Knosp grade 0-2). For the cost-efficiency metrics, the mean (SD) length of stay was 3.8 (4.8) midnights, and the percentage of patients readmitted was 11.1%. The rate of disposition to a skilled nursing facility was 2.2%. For surgical outcomes, the rate of postoperative CSF leakage was 1.3%, and the rate of 1-year sustained surgical remission was 81.2%. The rates of permanent and temporary arginine vasopressin deficiencies were 1.8% and 11.9%, respectively. The 75th percentile performance by center was 3.0 midnights for length of stay, 6.3% for 90-day unplanned readmission, < 1% for disposition to a skilled nursing facility, < 1% for CSF leakage, and 92.2% for 1-year sustained remission. The 75th percentile was < 1% for both permanent and temporary arginine vasopressin deficiencies.

Conclusions: An evidence-based bundle of metrics in a Cushing's disease patient population at low risk who underwent first-time endoscopic pituitary surgery is proposed. Surgeons can use these metrics to assess and improve the quality of their clinical pathways.

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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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