The slope of the learning curve in 600 consecutive endoscopic transsphenoidal pituitary surgeries.
Acta Neurochir (Wien)
; 162(10): 2361-2370, 2020 10.
Article
en En
| MEDLINE
| ID: mdl-32607745
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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Asunto principal:
Neoplasias Hipofisarias
/
Hueso Esfenoides
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Adenoma
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Procedimientos Neuroquirúrgicos
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Endoscopía
/
Curva de Aprendizaje
/
Cavidad Nasal
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Adult
/
Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Acta Neurochir (Wien)
Año:
2020
Tipo del documento:
Article
País de afiliación:
Estados Unidos