Han Jane S, Demetriou Alexandra N, Dallas Jonathan, Bae Gloria, Ding Li, Mack William J, Attenello Frank J, Zada Gabriel
1Departments of Neurological Surgery and.
2Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
J Neurosurg. 2025 Jun 27:1-10. doi: 10.3171/2025.3.JNS242018.
Prior studies have shown that high-volume centers have improved outcomes in patients undergoing transsphenoidal resection for pituitary tumors. However, those investigations have not examined this association specifically for the endoscopic approach and are limited by characterizing the volume outcome association using arbitrary dichotomous volume cutoffs. The objective of the current study was to delineate the continuous volume-outcome relationship adjusted for risk factors in patients with benign pituitary tumors undergoing endoscopic endonasal transsphenoidal surgery (ETSS) and systemically identify volume cutoffs after which there is no significant increase in complication risk.
In this retrospective analysis, the Nationwide Readmissions Database (NRD) was queried for patients with benign pituitary tumors who underwent ETSS from 2016 to 2018. ICD-10 coding was used for cohort selection. Patient and hospital characteristics were extracted from standard NRD-collected variables. The association of institutional procedural volume and outcomes (major complications, sellar tumor-specific complications, and discharge disposition) were evaluated using multivariable analysis.
A total of 14,947 patients (median age 56 years) with benign pituitary tumors who underwent ETSS were identified. Most patients received treatment at institutions with at least 13 cases per year (top 75th percentile). The multivariable analysis of volume as a continuous variable demonstrated that risk of major complications (e.g., sepsis) decreased at a steady rate (OR 0.984, 95% CI 0.977-0.992; p < 0.0001) per 1 procedure increase at institutions with a procedural volume of 1-57 cases per year. From 58 cases per year, there was no longer a decrease in risk (OR 1.001, 95% CI 0.996-1.006; p = 0.68). The risk of sellar tumor-specific complications (e.g., endocrinopathies and cranial nerve palsies) decreased throughout the entire volume range (OR 0.997, 95% CI 0.996-0.998; p < 0.0001). Furthermore, there was no linear response in discharge disposition, but the highest quartile was associated with the least likelihood of nonroutine discharge.
A multivariable analysis with institutional case volume as a continuous variable exhibited a linear association with risk of major and sellar tumor-specific complications specific to this patient population. Future studies are needed to further characterize the factors that contribute to this additive relationship.
先前的研究表明，高手术量中心在垂体瘤经蝶窦切除术患者中取得了更好的治疗效果。然而，这些研究并未专门针对内镜手术方法来研究这种关联，并且使用任意二分法手术量阈值来描述手术量与治疗效果的关联存在局限性。本研究的目的是在接受内镜鼻内经蝶窦手术（ETSS）的垂体瘤患者中，描绘调整风险因素后的连续手术量 - 治疗效果关系，并系统地确定手术量阈值，超过该阈值后并发症风险不再显著增加。
在这项回顾性分析中，查询了2016年至2018年接受ETSS的垂体瘤患者的全国再入院数据库（NRD）。使用ICD - 10编码进行队列选择。从NRD收集的标准变量中提取患者和医院特征。使用多变量分析评估机构手术量与治疗效果（主要并发症、鞍区肿瘤特异性并发症和出院处置）之间的关联。
共识别出14947例接受ETSS的垂体瘤患者（中位年龄56岁）。大多数患者在每年至少进行13例手术的机构接受治疗（第75百分位数以上）。将手术量作为连续变量的多变量分析表明，在每年手术量为1 - 57例的机构中，每增加1例手术，主要并发症（如败血症）的风险以稳定速率下降（OR 0.984，95%CI 0.977 - 0.992；p < 0.0001）。从每年58例开始，风险不再下降（OR 1.001，95%CI 0.996 - 1.006；p = 0.68）。鞍区肿瘤特异性并发症（如内分泌病和颅神经麻痹）的风险在整个手术量范围内均下降（OR 0.997，95%CI 0.996 - 0.998；p < 0.0001）。此外，出院处置方面没有线性反应，但最高四分位数与非常规出院的可能性最小相关。
以机构病例数作为连续变量的多变量分析显示，对于该患者群体，主要并发症和鞍区肿瘤特异性并发症的风险与之呈线性关联。未来需要进一步研究以进一步明确促成这种累加关系的因素。
