{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:33:17Z","timestamp":1788669197150,"version":"build-2803163510"},"reference-count":86,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Reports of surgical outcomes for Cushing\u2019s disease are mostly limited to single-center experiences by expert surgeons. Therefore, no generalizable surgical outcome metrics for endoscopic endonasal Cushing\u2019s 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\u2019s 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.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n 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\u20132). 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.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n An evidence-based bundle of metrics in a Cushing\u2019s 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.1.jns241286","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T21:47:06Z","timestamp":1748641626000},"page":"907-915","source":"Crossref","is-referenced-by-count":4,"title":["Outcome metrics for primary endoscopic endonasal surgery for low-risk patients with Cushing\u2019s disease: an evidence-based position statement from the Registry of Adenomas of the Pituitary and Related Disorders consortium"],"prefix":"10.3171","volume":"143","author":[{"given":"Michael","family":"Karsy","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun R.","family":"Kshettry","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garni","family":"Barkhoudarian","sequence":"additional","affiliation":[{"name":"Pacific Pituitary Disorders Center, Pacific Neuroscience Institute, Santa Monica, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donato R.","family":"Pacione","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, New York University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina G.","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami Health System, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Catalino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Rennert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M.","family":"Silverstein","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism and Lipid Research, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, The Ohio State College of Medicine, The Ohio State University, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie J.","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Chicoine","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Missouri, Columbia, Missouri; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"Little","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Neurosurgery","first-page":"240","article-title":"Endoscopic transsphenoidal surgery for Cushing disease: techniques, outcomes, and predictors of remission","volume":"72","author":"Starke RM","year":"2013","unstructured":"Starke RM, Reames DL, Chen CJ, Laws ER, Jane JA Jr. Endoscopic transsphenoidal surgery for Cushing disease: techniques, outcomes, and predictors of remission. 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