2026 Poster Presentations
P192: WIDE VARIABILITY AND INACCURACY IN THE AMERICAN COLLEGE OF SURGEONS NSQIP DATABASE FOR REPORTING OF PITUITARY SURGERY CASES
Sydney R Mittiga, BS1; Dara C Kissel, BS1; Jordon Grube, DO2; Robert Heller, MD2; 1Albany Medical College; 2Albany Medical Center
Introduction: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database is a variable-driven clinical database established to strengthen quality outcomes across participating institutions. Included among the datasets are pituitary tumor surgical cases, for which data is reported trans-institutionally. The NSQIP introduces an opportunity to homogenize reporting of pituitary surgery methods and complications, ultimately improving outcomes. Its usability depends on accurate data abstraction. Here, we highlight inconsistencies in NSQIP pituitary surgery reporting to inspire more accurate data abstraction guidelines for pituitary patients.
Methods: The NSQIP database was queried for pituitary surgery cases from the years 2022 through 2023. The data is a culmination of randomly selected cases from each participating hospital. Case percentages were calculated for each operative approach documented. Data was grouped into either correct or misclassified based on the operative approach listed in the report. Correctly classified data included operative approaches “endoscopic” and “open” as these are valid pituitary surgery methods. Misclassified data included operative approaches “Endoscopic, Natural Orifice Transluminal Endoscopic Surgery (NOTES),” “Percutaneous,” “Laparoscopic/ Endoscopic,” “MIS through Single incision (e.g. SILS, Uni- VATS), Natural Orifice Transluminal Endoscopic Surgery (NOTES),” “Natural Orifice Transluminal Endoscopic Surgery (NOTES),” “Natural Orifice Transluminal Endoscopic Surgery (NOTES),” “Open, Natural Orifice Transluminal Endoscopic Surgery (NOTES),” “Thoracoscopic, Endoscopic,” “Endoscopic, Other MIS,” “Other/MIS,” and “Open/Endoscopic,” as these were either approaches not used in pituitary surgery or ambiguous terminology that did not clearly specify the approach taken.
Results: 346 pituitary surgery cases were included in the generated NSQIP report: 187 from 2022 and 159 from 2023. The breakdown for correctly classified and misclassified operative approaches can be found in the table below.
Table 1. Overall, 79.2% of pituitary surgery operative approaches were correctly classified and 20.8% were misclassified. Microscopic approach may fall under “minimally invasive surgeries,” but it is not clearly represented.
Discussion: In 2022 and 2023, the NSQIP database included questions on operative approach for pituitary surgery, intended to accurately capture data representing pituitary surgery cases. However, inaccurate and vague answer choices made the dataset vulnerable to misclassification, undermining data validity. The evolving standard of care for pituitary surgery necessitates reliable and accurate data entry into nationwide databases that reflects the current state of pituitary surgery in the skull base community.