{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:28:35Z","timestamp":1788413315503,"version":"build-2803163510"},"reference-count":0,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>Although widely advocated, applying Value Based Health Care (VBHC) in clinical practice is challenging. This study describes VBHC-based perioperative outcomes for patients with pituitary tumors up to 6 months postoperatively.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 103 adult patients undergoing surgery were prospectively followed. Outcomes categorized according to the framework of VHBC included survival, degree of resection, endocrine remission, visual outcome (including self-perceived functioning), recovery of pituitary function, disease burden and health-related quality of life (HRQoL) at 6 months (Tier 1); time to recovery of disease burden, HRQoL, visual function (Tier 2); permanent hypopituitarism and accompanying hormone replacement (Tier 3). Generalized estimating equations (GEEs) analysis was performed to describe outcomes over time.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Regarding Tier 1, there was no mortality, 72 patients (70%) had a complete resection, 31 of 45 patients (69%) with functioning tumors were in remission, 7 (12%, with preoperative deficits) had recovery of pituitary function and 45 of 47 (96%) had visual improvement. Disease burden and HRQoL improved in 36\u201345% at 6 months; however, there were significant differences between tumor types. Regarding Tier 2: disease burden, HRQoL and visual functioning improved within 6 weeks after surgery; however, recovery varied widely among tumor types (fastest in prolactinoma and non-functioning adenoma patients). Regarding Tier 3, 52 patients (50%) had persisting (tumor and treatment-induced) hypopituitarism.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Though challenging, outcomes of a surgical intervention for patients with pituitary tumors can be reflected through a VBHC-based comprehensive outcome set that can distinguish outcomes among different patient groups with respect to tumor type.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-19-0344","type":"journal-article","created":{"date-parts":[[2019,7,24]],"date-time":"2019-07-24T13:07:22Z","timestamp":1563973642000},"page":"375-387","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":32,"title":["Toward Value Based Health Care in pituitary surgery: application of a comprehensive outcome set in perioperative care"],"prefix":"10.1093","volume":"181","author":[{"given":"Daniel J","family":"Lobatto","sequence":"first","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"2Department of Neurosurgery, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir H","family":"Zamanipoor Najafabadi","sequence":"additional","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"2Department of Neurosurgery, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friso","family":"de Vries","sequence":"additional","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"3Division of Endocrinology, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelie D","family":"Andela","sequence":"additional","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"3Division of Endocrinology, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilbert B","family":"van den Hout","sequence":"additional","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"4Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto M","family":"Pereira","sequence":"additional","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"3Division of Endocrinology, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilco C","family":"Peul","sequence":"additional","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"2Department of Neurosurgery, Department of Medicine"},{"name":"4Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"5Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thea P M","family":"Vliet Vlieland","sequence":"additional","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"6Department of Orthopedics, Physical Therapy and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter R","family":"van Furth","sequence":"additional","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"2Department of Neurosurgery, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nienke R","family":"Biermasz","sequence":"additional","affiliation":[{"name":"1Center for Endocrine Tumors Leiden, Department of Medicine"},{"name":"3Division of Endocrinology, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","container-title":["European Journal of Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/181\/4\/EJE-19-0344.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/181\/4\/EJE-19-0344.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T16:13:33Z","timestamp":1676391213000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/181\/4\/375\/6654049"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":0,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.1530\/eje-19-0344","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10]]}}}