Study offers evidence of a volume-outcome link for surgeons carrying out specialist endoscopic pituitary surgery

A GIRFT-led study to support the setting of minimum annual volumes for surgeons carrying out endoscopic surgery on the pituitary gland has been published in the British Journal of Neurosurgery.

A team of GIRFT researchers examined the data of almost 4,600 endoscopic transsphenoidal pituitary surgery (ETSPS) patients who had procedures in England between April 2013 and March 2019 for benign neoplasm – this is surgery to remove non-cancerous tumours from the pituitary gland using small telescopes (endoscopes) inserted through the sphenoid sinus. The surgery examined was carried out across 24 hospitals and by 150 surgeons.

The study found that the patients of surgeons who carried out more ETSPS operations every year were significantly less likely to return to hospital for repeat ETSPS surgery within a year. They also spent less time in hospital and were less likely to experience a bleed after surgery.

This supports findings outlined in the GIRFT national report for cranial neurosurgery (2018), which showed that, between 2013 to 2017, 107 surgeons carried out 4,232 pituitary surgery procedures in England. Of those, 18 surgeons conducted more than 100 procedures, while half conducted fewer than 10, and 45 carried out only one operation in the four years.

The GIRFT report pledged to assess the evidence base for low volume operating and to commission research into the relationship between surgical volumes and patient outcomes.

Published this month, the study in the British Journal of Neurosurgery offers evidence that a surgeon volume-outcome relationship exists for ETSPS in England and supports the concept of setting minimum annual volumes for surgeons carrying out the procedure. However, it concludes that further data from patients, surgeons, service managers and other key stakeholders should be collected to help reach a decision on what that threshold should be.

GIRFT’s research team comprised William Gray (senior research associate), Annakan Navaratnam (former GIRFT fellow), Tim Briggs (chair of GIRFT and NHS England’s national director for clinical improvement and elective recovery), and Nick Phillips (GIRFT clinical lead for cranial neurosurgery and consultant neurosurgeon at Leeds Teaching Hospitals NHS Trust). They were joined by Catherine Rennie (consultant ENT surgeon at Imperial College Healthcare NHS Trust) and Nigel Mendoza (consultant neurosurgeon at Imperial College Healthcare NHS Trust).

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