Benchmarking Surgical Outcomes for Endoscopic Transnasal Craniopharyngioma Resection: Implications for Clinical Practice From the RAPID Consortium.
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Tenhoeve Samuel A, Orton Cody, Gautam Diwas, Silverstein Julie M, Kim Albert H, Evans James J, Barkhoudarian Garni, Fernandez-Miranda Juan C, Pacione Donato R, Kim Won, Bergsneider Marvin, Chicoine Michael R, Zada Gabriel, Kshettry Varun R, Wu Kyle C, Prevedello Daniel M, Benjamin Carolina G, Van Gompel Jamie, Palit Sandhya R, Catalino Michael P, Mamelak Adam N, Zwagerman Nathan T, Cheok Stephanie K, Little Andrew S, Mendoza Michelle Magaña, Zenonos Georgios A, Gardner Paul A, Karsy Michael, Morshed Ramin A, Blackburn Spiros L, Mukherjee Debraj, Beer-Furlan Andre, Couldwell William T, Rennert Robert C, RAPID Consortium
Аннотация
METHODS: A retrospective cohort of adult patients (18 years and older) with craniopharyngioma undergoing a first-time endoscopic transnasal surgery across 14 academic centers in the United States was analyzed using data collected from 2011 to 2024. Patients were stratified into low-risk and high-risk cohorts based on criteria including age, body mass index, selected tumor characteristics (size, infundibular relationship, intraventricular extension), and previous radiation. Surgical outcomes were analyzed, and benchmarking ranges were defined using the established methodology.
RESULTS: The overall cohort included 318 patients with a mean age of 50 years. Upon benchmarking analysis (50th-75th percentile performance), low-risk patients (n = 136) had a median length of stay of 4.0 to 6.0 days, 90-day readmission rates of 15.5% to 22.2%, skilled nursing facility discharge rates of <1.0%, postoperative cerebrospinal fluid leak incidence of <1.0% to 14.3%, gross total resection rates of 50.0% to 60.8%, new postoperative arginine vasopressin deficiency rates of 33.3% to 50.0%, and tumor progression/recurrence rates of <1.0% to 18.3% over a median follow-up period of 27.0 (IQR 10.5-56.5) months. Benchmarking ranges were proposed for each outcome to facilitate cross-institutional comparisons.
CONCLUSION: Establishing surgical outcome benchmarks for adult patients undergoing craniopharyngioma resection using data from the Registry of Adenomas of the Pituitary and Related Disorders provides a framework for assessing surgical performance and guiding clinical decision-making. Benchmark ranges can inform institutional quality improvement efforts, perioperative risk stratification, and patient counseling regarding expected postoperative outcomes.