2026 Proffered Presentations
S030: SURGEON EXPERIENCE AND OUTCOMES IN CUSHING'S DISEASE: A MULTICENTER STUDY
Alexander C Greven, MD, MBA1; Mark Pacult, MD1; Kassu M Beyene, MS1; Carolina G Benjamin, MD2; Marvin Bergsneider, MD3; James Evans, MD4; Juan C Fernandez-Miranda, MD5; Paul A Gardner, MD6; Michael Karsy, MD7; Varun Kshettry, MD8; Adam Mamelak, MD9; Donato R Pacione, MD10; Robert C Rennert, MD11; Julie Silverstein, MD12; Daniel F Kelly, MD13; Kyle Wu, MD14; Gabriel Zada, MD15; Andrew S Little, MD, MBA1; 1Barrow Neurological Institute; 2Miami Miller School of Medicine; 3University of California, Los Angeles; 4Thomas Jefferson University; 5Stanford University; 6University Pittsburgh Medical Center; 7University of Michigan Medical School; 8Cleveland Clinic; 9Cedar Sinai Medical Center; 10NYU Langone Health; 11University of Utah Health; 12Washington University in St. Louis; 13Pacific Neuroscience Institute; 14Ohio State University Wexner Medical Center; 15USC Keck School of Medicine
Introduction: Prior studies investigating the relationship of surgeon experience to patient outcomes in Cushing’s disease (CD) have yielded inconsistent results and are generally limited by single surgeon experiences.
Objective: Describe the association between surgeon experience and outcomes for CD.
Methods: An exploratory analysis of the Registry of Adenomas and Related Disorders (RAPID) was conducted on patients treated with transsphenoidal surgery (TS) for CD. Surgeon experience was defined as the number of individual lifetime TS surgeries performed at the time of surgery. Length of stay, surgical complications (e.g. hyponatremia, diabetes insipidus, CSF leak, death, etc.), unexpected readmission within 90 days, reoperation within 90 days, and post-operative hormonal remission at last follow up were evaluated. Univariate and multivariable analyses were performed.
Results: Eight hundred and eighteen patients treated by 41 surgeons at 13 institutions were included. On univariate analysis, less experienced surgeons (<500 cases) had a significantly higher rate of complications (42.6% vs. 21.2%, p<0.001) and longer length of stay (5.1 +/- 4.5 days vs. 3.4 +/- 2.8, p<0.001) compared to experienced surgeons (>500 cases). On multivariate analysis controlling for age, sex, ethnicity, BMI, modified frailty index, tobacco use, Knosp grade, tumor volume, and follow up time the more experienced surgeons had fewer complications (OR 0.344 [0.185, 0.641], p<0.001) and shorter length of stay (OR -2.011 [-3.164, -0.858], p<0.001). There were no differences in unplanned readmission (OR 1.015 [0.397, 2.595], p=0.975), reoperation (OR 0.847 [0.235, 3.050], p=0.800), or biochemical remission at last follow up (OR 0.720 [0.314, 1.647], p=0.436). In MRI negative cases, there were no differences in complications (OR 0.208 [0.0.038, 1.148], p=0.665), readmission (OR 0.639 [0.083, 4.929], p=0.304), reoperation (OR 0.150 [0.011, 2.116], p=0.294), or remission (OR 0.343 [0.0.072, 1.645], p=0.596) between less experienced and more experienced surgeons.
Conclusion: Experienced surgeons have fewer complications and shorter length of stay in the surgical treatment of Cushing’s disease compared to less experienced surgeons. There was no difference in biochemical remission between the more experienced and less experienced surgeons.