2026 Proffered Presentations
S029: DEVELOPMENT OF A CORE OUTCOMES SET (COS) IN SURGICAL NONFUNCTIONAL PITUITARY ADENOMA RESEARCH: A MULTIDISCIPLINARY RAPID CONSORTIUM EFFORT
Kara A Parikh, MD1; Won Kim, MD2; Michael Catalino, MD3; Michael Chicoine, MD4; Michael Karsy, MD5; Donato Pacione, MD6; Andrew S Little, MD7; Varun Kshettry, MD8; Pablo Recinos, MD8; Gabriel Zada, MD9; Garni Barkhoudarian, MD10; Juan Fernandez-Miranda, MD11; Robert Rennert, MD12; James Evans, MD13; Ramin Morshed, MD14; Georgios Zenonos, MD15; Adam Mamelak, MD16; Spiros L Blackburn, MD17; Jamie Van Gompel, MD18; Kyle Wu, MD1; Albert Kim, MD19; Stephanie Cheok, MD20; 1The Ohio State University, Department of Neurosurgery; 2University of California, Los Angeles, Department of Neurosurgery; 3University of Virginia, Department of Neurosurgery; 4University of Missouri, Department of Neurosurgery; 5University of Michigan, Department of Neurosurgery; 6New York University, Department of Neurosurgery; 7Barrow Neurological Institute; 8Cleveland Clinic, Department of Neurosurgery; 9University of Southern California, Department of Neurosurgery; 10Pacific Neuroscience Institute; 11Stanford University, Department of Neurosurgery; 12University of Utah, Department of Neurosurgery; 13Thomas Jefferson University, Department of Neurosurgery; 14University of California, San Francisco, Department of Neurosurgery; 15University of Pittsburgh Medical Center, Department of Neurosurgery; 16Cedars-Sinai, Department of Neurosurgery; 17The University of Texas Health Science Center at Houston; 18Mayo Clinic, Department of Neurosurgery; 19Washington University School of Medicine; 20Medical College of Wisconsin, Department of Neurosurgery
Background: Pituitary adenoma outcomes research has high output with approximately 350 indexed publications annually. However, there is poor concordance and high variability of outcome measures reported. This heterogeneity was highlighted by Horsfall et al. in Pituitary, where his group analyzed 178 papers and found that the most commonly reported outcome was surgical complications (65%), with other variables below 50%. The variability in both outcome reporting and institutional practices can pose a challenge for high-powered research and impactful evidence-based care. A solution to this is the development of a core outcomes set (COS). The COS is a standardized minimum list of outcomes to be reported when publishing outcomes research for a specific pathology, generated by a consortium of experts specializing in the field. We report the development of a COS for surgical nonfunctional pituitary adenomas (NFPA).
Methods: The study design was based on recommendations for the development of a COS (Figure 1). Given the surgical focus of the NFPA-COS, stakeholders and panelist experts were limited to physicians providing direct and focused care to patients with NFPA from 19 academic institutions that are members of the U.S. Registry of Adenomas of the Pituitary and Related Disorders (RAPID) consortium. Each institution in the consortium was invited to nominate a neurosurgeon, otolaryngologist, endocrinologist, and ophthalmologist specializing in the treatment of NFPA, with 17 institutions participating. An online Delphi survey was sent to each stakeholder to identify and develop a consensus on fundamental outcomes to be reported in pituitary adenoma surgery research. Voting took place in a Likert scale format, grouped into results labeled: “Include” (7-9), “Recommend” (4-6), “Exclude” (1-3). Items with ≥75% consensus form the provisional Core Outcomes Set, with items without consensus rolling over for further voting in the following round.
Results: Round one of the Delphi survey was sent to 47 invited stakeholders from 19 institutions. Seventeen institutions participated, with 35 total stakeholders. These voters were comprised of 18 neurosurgeons, 9 endocrinologists, 7 otolaryngologists, and 1 ophthalmologist. There were 22 total voting items, including 16 Likert scale format voting items and 6 free text or multiple-choice questions. Preliminary results after first round include consensus on 9 items. Results of the survey are shown in in Table 1.
Conclusions: We present early results of a surgical NFPA core outcomes set. Consensus standardization of reporting outcomes provides pituitary subspecialists a tool to facilitate data collection and collaboration amongst institutions. This guideline promotes consistent centralized data for research. Further efforts will be directed at adding definitions to previously reported outcomes and will culminate in an in-person meeting at the 2026 annual meeting of the North American Skull Base Society.
References:
1. Layard Horsfall, H., Lawrence, A., Venkatesh, A., Loh, R.T., Jayapalan, R., Koulouri, O., Sharma, R., Santarius, T., Gurnell, M., Dorward, N. and Mannion, R., 2023. Reported outcomes in transsphenoidal surgery for pituitary adenomas: a systematic review. Pituitary, 26(2), pp.171-181.
2. Kirkham, J.J., Davis, K., Altman, D.G., Blazeby, J.M., Clarke, M., Tunis, S. and Williamson, P.R., 2017. Core outcome Set-STAndards for development: the COS-STAD recommendations. PLoS medicine, 14(11), p.e1002447.