Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA.
Department of Neurosurgery, Drexel University College of Medicine, Drexel University, Philadelphia , Pennsylvania , USA.
Neurosurgery. 2024 Aug 1;95(2):372-379. doi: 10.1227/neu.0000000000002888. Epub 2024 Mar 5.
To address the lack of a multicenter pituitary surgery research consortium in the United States, we established the Registry of Adenomas of the Pituitary and Related Disorders (RAPID). The goals of RAPID are to examine surgical outcomes, improve patient care, disseminate best practices, and facilitate multicenter surgery research at scale. Our initial focus is Cushing disease (CD). This study aims to describe the current RAPID patient cohort, explore surgical outcomes, and lay the foundation for future studies addressing the limitations of previous studies.
Prospectively and retrospectively obtained data from participating sites were aggregated using a cloud-based registry and analyzed retrospectively. Standard preoperative variables and outcome measures included length of stay, unplanned readmission, and remission.
By July 2023, 528 patients with CD had been treated by 26 neurosurgeons with varying levels of experience at 9 academic pituitary centers. No surgeon treated more than 81 of 528 (15.3%) patients. The mean ± SD patient age was 43.8 ± 13.9 years, and most patients were female (82.2%, 433/527). The mean tumor diameter was 0.8 ± 2.7 cm. Most patients (76.6%, 354/462) had no prior treatment. The most common pathology was corticotroph tumor (76.8%, 381/496). The mean length of stay was 3.8 ± 2.5 days. The most common discharge destination was home (97.2%, 513/528). Two patients (0.4%, 2/528) died perioperatively. A total of 57 patients (11.0%, 57/519) required an unplanned hospital readmission within 90 days of surgery. The median actuarial disease-free survival after index surgery was 8.5 years.
This study examined an evolving multicenter collaboration on patient outcomes after surgery for CD. Our results provide novel insights on surgical outcomes not possible in prior single-center studies or with national administrative data sets. This collaboration will power future studies to better advance the standard of care for patients with CD.
为解决美国缺乏多中心垂体手术研究联盟的问题，我们建立了垂体腺瘤和相关疾病登记处（RAPID）。RAPID 的目标是检查手术结果，改善患者护理，传播最佳实践，并促进大规模的多中心手术研究。我们最初的重点是库欣病（CD）。本研究旨在描述当前 RAPID 患者队列，探讨手术结果，并为解决以前研究的局限性奠定基础。
使用基于云的登记处汇总了来自参与站点的前瞻性和回顾性获得的数据，并进行了回顾性分析。标准的术前变量和结果测量包括住院时间、非计划再入院和缓解。
截至 2023 年 7 月，26 名神经外科医生在 9 个学术垂体中心对 528 例 CD 患者进行了治疗，这些医生的经验水平各不相同。没有一位医生治疗超过 528 例患者中的 81 例（15.3%）。患者的平均年龄为 43.8 ± 13.9 岁，大多数患者为女性（82.2%，433/527）。肿瘤平均直径为 0.8 ± 2.7cm。大多数患者（76.6%，354/462）没有接受过治疗。最常见的病理是促皮质素瘤（76.8%，381/496）。平均住院时间为 3.8 ± 2.5 天。最常见的出院地点是家（97.2%，513/528）。两名患者（0.4%，2/528）在围手术期死亡。共有 57 例患者（11.0%，57/519）在手术后 90 天内需要非计划再次住院。指数手术后的中位实际无病生存时间为 8.5 年。
本研究检查了一项针对 CD 手术后患者结局的多中心合作的演变。我们的结果提供了以前单中心研究或国家行政数据集无法获得的关于手术结果的新见解。该合作将为未来的研究提供动力，以更好地推进 CD 患者的护理标准。
