Surgeon Experience and Outcomes in Cushing's Disease: A Multicenter Study

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). 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 with less experienced surgeons. There was no difference in biochemical remission between the more experienced and less experienced surgeons. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany