Outcome squares integrating efficacy and safety, as applied to functioning pituitary adenoma surgery

Vries Friso de; Daniel Lobatto; Marco Verstegen; Pieter Schutte; Irene Notting; Mark Kruit; Fasial Ahmed; Alberto M Pereira; Furth Wouter van; Nienke Biermasz

doi:10.1530/endoabs.70.AEP1076

AEP1076

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Endocrine Abstracts (2020) 70 AEP1076 | DOI: 10.1530/endoabs.70.AEP1076

ECE2020 Audio ePoster Presentations Hot topics (including COVID-19) (110 abstracts)

Outcome squares integrating efficacy and safety, as applied to functioning pituitary adenoma surgery

Friso de Vries ¹ , Daniel Lobatto ² , Marco Verstegen ² , Pieter Schutte ² , Irene Notting ³ , Mark Kruit ⁴ , Fasial Ahmed ¹ , Alberto M Pereira ¹ , Wouter van Furth ² & Nienke Biermasz ¹

Err

Author affiliations

¹Leiden University Medical Center (LUMC), Endocrinology, Leiden, Netherlands; ²Leiden University Medical Center (LUMC), Neurosurgery, Leiden, Netherlands; ³Leiden University Medical Center (LUMC), Ophthalmology, Leiden, Netherlands; ⁴Leiden University Medical Center (LUMC), Radiology, Leiden, Netherlands

Background: Transsphenoidal surgery is standard care in the treatment of hormone-secreting pituitary adenomas. Current clinician-reported surgical outcome measures are one-dimensional, typically focussing primarily on complete or partial resection and secondarily on complication rates. However, outcomes are best reflected by the delicate balance of efficacy and complications at patient level. This study proposes a novel way to classify outcome, integrating efficacy and safety at the patient level.

Methods: Retrospective chart review of all pure endoscopic transsphenoidal surgical procedures for acromegaly, Cushing’s disease, and prolactinoma between 2010–2018 in a single tertiary referral centre. We present our results in a classic (remission and complications separate) and in a novel Outcome Square integrating intended and adverse effects (long-term complications). This resulted in four outcome groups, ranging from good to poor. We use this approach to present these outcomes for several clinically relevant subgroups.

Findings: 198 surgical procedures were included (44 reoperations). Remission was achieved in 127 operations (64%). Good outcome was observed after 121 (61%), and poor outcome after 6 (3%) operations. When intended effect of surgery was applied (instead of remission), good outcome was achieved after 148 of 198 surgeries (75%) and poor outcome after 4 (2%).

Interpretation: Quality of a surgical intervention can be presented in 4 simple categories, integrating both efficacy and safety with flexibility to adapt to the individualized situation at patient, disease, and surgical strategy. Funding. No specific funding was received for this research

Table 1 Construction of the Outcome Square, a contingency table integrating efficacy with safety. Definitions of remission, intended effect and adverse effect are provided in the methods section. IOQ: integrated outcome quadrant (1–4).