1158 Disparities in Protocol Exposure and Outcomes of TNTS Resection for Cushing’s Disease: A Multi-Institutional Analysis

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INTRODUCTION: Racial and ethnic disparities in Cushing’s Disease (CD) remain poorly characterized. METHODS: We analyzed retrospective data from the Registry of Adenomas of the Pituitary and Related Disorders for patients who underwent transnasal transsphenoidal (TNTS) resection for CD between 2003–2023 at one of thirteen institutions. Race and ethnicity were modeled using binary indicators with White and non-Hispanic as references. RESULTS: Ethnicity and race data were available for 734 and 672 patients, respectively. In bivariable ordinal regression, Black race (p = 0.010) and Hispanic ethnicity (p = 0.049) were associated with higher Knosp grade. Black race was associated with decreased odds of gross total resection (GTR) (p = 0.018), increased LOS (p < 0.001), and increased odds of any postoperative complication (OR = 1.90, p = 0.018), CSF leak (OR = 4.16, p = 0.002), and AVP deficiency (OR = 2.62, p = 0.002). Black patients had lower odds of undergoing surgeries utilizing intraoperative checklists (OR = 0.21, p < 0.001), while Hispanic patients had greater odds of undergoing protocolized care (OR = 2.14, p = 0.008). In multivariable models, intraoperative checklists were protective against any complication (OR = 0.36, p = 0.008), CSF leak (OR = 0.08, p = 0.015), and AVP deficiency (OR = 0.21, p = 0.001), and were associated with increased odds of GTR (OR = 3.28, p = 0.020). Protocol implementation was protective against CSF leak (OR = 0.28, p = 0.027). Endoscopic (versus microscopic) surgery was associated with decreased complication risk (OR = 0.24, p = 0.041). After adjusting for BMI, Asian race was not associated with hyponatremia. CONCLUSIONS: Black and Hispanic patients presented with more extensive cavernous sinus invasion, but only Black race was associated with increased complication risk and lower GTR rates. Black patients were less likely to undergo surgeries utilizing intraoperative checklists, which, together with protocol implementation, was associated with improved outcomes regardless of race. Associations of race with adverse outcomes persisted after adjusting for protocol-based factors, suggesting that standardized care pathways may improve outcomes for all patients, but disparities in outcomes are not fully explained by disparities in care standardization.

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