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The slope of the learning curve in 600 consecutive endoscopic transsphenoidal pituitary surgeries.

TitleThe slope of the learning curve in 600 consecutive endoscopic transsphenoidal pituitary surgeries.
Publication TypeJournal Article
Year of Publication2020
AuthorsYounus I, Gerges MM, Uribe-Cardenas R, Morgenstern P, Kacker A, Tabaee A, Anand VK, Schwartz TH
JournalActa Neurochir (Wien)
Volume162
Issue10
Pagination2361-2370
Date Published2020 10
ISSN0942-0940
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.

DOI10.1007/s00701-020-04471-x
Alternate JournalActa Neurochir (Wien)
PubMed ID32607745