Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, The Netherlands; Centre for Endocrine Tumors Leiden, Leiden University Medical Centre, Albinusdreef 2, The Netherlands.
Centre for Endocrine Tumors Leiden, Leiden University Medical Centre, Albinusdreef 2, The Netherlands; Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, The Netherlands.
Arch Med Res. 2023 Dec;54(8):102918. doi: 10.1016/j.arcmed.2023.102918. Epub 2023 Nov 25.
Growth-hormone-producing pituitary adenomas have variable likelihood for biochemical remission (BR). During preoperative counseling, individual estimated surgical likelihoods/risks should be balanced against alternative (medical) treatments, which is necessary for accurate outcome presentation. Preoperative estimation of BR or total resection (TR) likelihoods have not been reported, resulting in extrapolation of individual outcomes.
To share an innovative outcome reporting paradigm by integrating surgical decision-making, and expected/realized results, resulting from the Value-Based Health Care (VBHC) care path with periodical performance evaluation and care innovation cycle.
Prospective cohort study of consecutive patients with acromegaly undergoing surgery (January 2016-December 2020; postoperative follow-up ≥6 months) reporting on both classic, and novel innovative outcome evaluations.
Fifty eight patients (66 procedures) were included. Intended TR was achieved in 34/50 procedures, whereas intended debulking was achieved in 15/16 procedures. 38/66 procedures resulted in BR, and 4 procedures resulted in permanent complications. Achieving intended surgical goal was estimated preoperatively as likely in 33 (goal achieved (GA) in 28/33), potentially in 27 (GA in 19/27), and unlikely in 6 procedures (GA in 2/6). Integrated Outcome Square 1 (IOQ1) -intended effect achieved without complications- was achieved in 46/66 patients.
Implementation of the developed quality process positively affects preoperative individual shared decision-making, resulting in improved (individual) outcomes, particularly in complex patients for whom preoperative chances are not fully reflected by tumor size and KNOSP grade, e.g., reoperations, or other challenging circumstances identified during preoperative counseling. Through repeated evaluations, our own team's knowledge increased, allowing for improved individualized treatment strategies.
生长激素型垂体腺瘤有不同的生化缓解（BR）可能性。在术前咨询中，应权衡个体估计的手术可能性/风险与替代（药物）治疗，这对于准确呈现结果是必要的。目前尚未报道术前预测 BR 或全切率（TR）的可能性，导致个体结果的推断。
通过整合基于价值的医疗保健（VBHC）护理路径中的手术决策以及由此产生的预期/实际结果，并进行定期绩效评估和护理创新循环，分享一种创新的结果报告范例。
对 2016 年 1 月至 2020 年 12 月期间接受手术治疗（术后随访≥6 个月）的肢端肥大症连续患者进行前瞻性队列研究，报告经典和创新的新型结果评估。
共纳入 58 例（66 例手术）患者。34/50 例手术达到了预期的 TR，而 15/16 例手术达到了预期的减瘤效果。38/66 例手术实现了 BR，4 例手术出现了永久性并发症。术前预计达到预期手术目标的可能性为 33 例（28/33 例达到 GA），可能性为 27 例（19/27 例达到 GA），6 例不太可能（2/6 例达到 GA）。66 例患者中有 46 例（IOQ1）达到了预期的效果，没有出现并发症。
实施开发的质量流程对术前个体共享决策产生积极影响，改善了（个体）结果，特别是对术前情况不能完全反映肿瘤大小和 KNOSP 分级的复杂患者，例如再次手术或术前咨询中发现的其他具有挑战性的情况。通过反复评估，我们自己的团队的知识得到了提高，从而能够制定出更好的个体化治疗策略。
