Purpose Systematic review and meta-analysis comparing endoscopic and microscopic transsphenoidal surgery for Cushing's disease regarding surgical outcomes (remission, recurrence, and mortality) and complication rates. To stratify the results by tumor size. Methods Nine electronic databases were searched in February 2017 to identify potentially relevant articles. Cohort studies assessing surgical outcomes or complication rates after endoscopic or microscopic transsphenoidal surgery for Cushing's disease were eligible. Pooled proportions were reported including 95% confidence intervals. Results We included 97 articles with 6695 patients in total (5711 microscopically and 984 endoscopically operated). Overall, remission was achieved in 5177 patients (80%), with no clear difference between both techniques. Recurrence was around 10% and short term mortality < 0.5% for both techniques. Cerebrospinal fluid leak occurred more often in endoscopic surgery (12.9 vs. 4.0%), whereas transient diabetes insipidus occurred less often (11.3 vs. 21.7%). For microadenomas, results were comparable between both techniques. For macroadenomas, the percentage of patients in remission was higher after endoscopic surgery (76.3 vs. 59.9%), and the percentage recurrence lower after endoscopic surgery (1.5 vs. 17.0%). Conclusions Endoscopic surgery for patients with Cushing's disease reaches comparable results for microadenomas, and probably better results for macroadenomas than microscopic surgery. This is present despite the presumed learning curve of the newer endoscopic technique, although confounding cannot be excluded. Based on this study, endoscopic surgery may thus be considered the current standard of care. Microscopic surgery can be used based on neurosurgeon's preference. Endocrinologists and neurosurgeons in pituitary centers performing the microscopic technique should at least consider referring Cushing's disease patients with a macroadenoma.

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Context: Transsphenoidal surgery is standard care in the treatment of hormonesecreting pituitary adenomas. Current clinician-reported surgical outcome measures are one-dimensional, typically focusing primarily on complete or partial resection, and secondarily on complication rates. However, outcomes are best reflected by the delicate balance of efficacy and complications at patient level. Objective: This study proposes a novel way to classify and report outcomes, integrating efficacy and safety at the patient level. Methods: Retrospective chart review of all pure endoscopic transsphenoidal surgical procedures for acromegaly, Cushing's disease, and prolactinoma between 2010 and

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Objectives: Complications in instrumental spinal surgeries (ISS) pose a considerable burden on patients. Necessary reoperations are associated with significant resource utilization and cost and from the perspective of the German Statutory Health Insurance (SHI). Dependable data on the frequency of reoperations and associated costs are lacking for Germany. The aim of this study was to estimate the incidence of ISS and consecutive reoperations, and to calculate the related costs. MethOds: We conducted a retrospective claims data analysis using the Health Risk Institute research database, which contains anonymized claims data and covers approximately 5.42% of the German population. The study period comprised 01 January 2009 to 31 December 2011. An algorithm of operation and procedure codes (OPS) identified primary ISS and following reoperations. Reoperation rates were calculated for an individual period of 12 months after the primary ISS in 2010. Annual costs for reoperations were calculated based on group comparison of patients with reoperation and those without reoperation (control group). Existing differences in cost levels in the year before the primary ISS were adjusted by the difference in differences approach. Results: A total of 3,316 individuals had a primary ISS in 2010. The reoperation rate was 9.98% (95% CI = 8.98% to 11.02%). Mean cost per ISS was € 11,331 for all patients (€ 13,358 reoperation group, € 11,106 control group). The mean adjusted annual cost for a reoperation was € 11,370, with € 8,432 directly attributed to the reoperation procedure and € 2,938 to excess costs in the first year after the primary ISS. cOnclusiOns: The direct cost of ISS has a significant impact on health insurance budgets. With 10% of primary ISS patients requiring a reoperation in Germany, their associated annual costs are relevant from the SHI perspective. As demonstrated elsewhere, these cost might be partly avoidable by using intra-operative 3-D imaging with navigation.Objectives: This study aims to estimate the incidence and costs of osteoporotic fractures in The Netherlands in 2010 and project them to 2030. MethOds: The incidence and health care costs of fractures were derived from claims data of all health care insurers in The Netherlands. We obtained 5-year age-and gender-specific costs of patients with and without fractures. Cost included hospital admission, physical therapy, occupational therapy, general practitioner and medication. In order to attribute fractures to osteoporosis we used a large dataset from a general hospital that included patients with a fracture screened with Dexa scan. Future projections were based on four different scenarios: 1. demographic scenario, 2. demographic+trend in incidence scenario, 3. demographic+trend in incidence+trend in cost scenario, and 4. increased treatment scenario. Results: Of all registered fractures 32% could be attributed to osteoporosis. In women this percentage was larger than in men (36 versus 21 %). This resulted in an incidence for all osteoporotic fractures of ...