Validation of criteria for defining Pituitary Tumors Centers of Excellence (PTCOE)

Author:

Giustina Andrea1,Uygur Melin Meliha2,Frara Stefano1,Barkan Ariel3,Biermasz Nienke R.4,Chanson Philippe5,Freda Pamela U.6,Gadelha Monica7,Kaiser Ursula B.8,Lamberts Steven W.J.9,Laws Edward10,Nachtigall Lisa B.11,Popovic Vera12,Reincke Martin13,Strasburger Christian14,Lely Aart J. van der15,Wass John A.H.16,Melmed Shlomo17,Casanueva Felipe F.18

Affiliation:

1. Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele

2. Recep Tayyip Erdoğan University

3. University of Michigan Health System

4. Leiden University Medical Center

5. Univ. Paris-Sud, Le Kremlin- Bicêtre

6. Columbia University, Vagelos College of Physicians and Surgeons

7. Instituto Estadual do Cérebro Paulo Niemeyer

8. Harvard Medical School

9. Erasmus Medical Center

10. Brigham & Women's Hospital

11. Massachusetts General Hospital, Harvard Medical School

12. University of Belgrade

13. LMU University Hospital, LMU Munich

14. Charité Universitätsmedizin

15. Erasmus University Medical Center

16. University of Oxford

17. Cedars-Sinai Medical Center

18. Santiago de Compostela University and Ciber OBN

Abstract

Abstract Purpose The Pituitary Society established the concept and mostly qualitative parameters for defining uniform criteria for pituitary tumor centers of excellence (PTCOEs) based on expert consensus. To validate those previously proposed criteria through collection and evaluation of self-reported activity of several internationally-recognized tertiary pituitary centers, thereby transforming the qualitative 2017 definition into a validated quantitative one, which could serve as the basis for future objective PTCOE accreditation. Methods An ad-hoc prepared database protocol was distributed to 9 Pituitary Centers chosen by the project scientific committee and comprising Centers of worldwide repute, which agreed to provide activity information derived from registries related to the years 2018-2020 and completing the database within 60 days. The database, composed of Excel® spreadsheets with requested specific information on leading and supporting teams provided by each Center, was reviewed by two blinded referees and all 9 of 9 candidate centers satisfied the overall PTCOE definition, according to referees’ evaluations. To obtain objective numerical criteria, median values for each activity/parameter were considered as the ideal PTCOE definition target, whereas the low limit of the range was selected as the acceptable target for each respective parameter. Results Three dedicated pituitary neurosurgeons were considered ideal, whereas one dedicated surgeon was acceptable. Moreover, 100 surgical procedures per year is ideal, while the results indicated that 50 surgeries per year is acceptable. Acute post-surgery complications, including mortality and readmission rates, should ideally be negligible or nonexistent, but acceptable criterion was a rate lower than 10% of patients with complications requiring readmission within 30 days after surgery. Four endocrinologists devoted to pituitary diseases are requested in a PTCOE and the total population of patients followed in a PTCOE should not be less than 850. It appears acceptable that at least one dedicated/expert in pituitary diseases is required in neuroradiology, pathology, and ophthalmology groups, whereas at least two expert radiation oncologists are needed. Conclusion This is, to our knowledge, the first study to survey and evaluate the activity of a relevant number of high-volume centers in the pituitary field. This effort, internally validated by ad-hocreviewers, allowed for transformation of previously formulated theoretical criteria for the definition of a PTCOE to precise numerical definitions based on real-life evidence. The application of a derived objective model can be used by external bodies for accreditation of pituitary centers as PTCOEs.

Publisher

Research Square Platform LLC

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