Racial and ethnic differences in presentation and postoperative recovery after transsphenoidal surgery for cushing...

Area of Science:

• Endocrinology
• Neurosurgery
• Health Disparities

Background:

• Cushing's disease (CD) is a rare endocrine disorder caused by excess cortisol.
• Transsphenoidal surgery (TSS) is the primary treatment for CD.
• Understanding race- and ethnicity-associated differences in surgical outcomes is crucial for equitable care.

Purpose of the Study:

• To identify at which points in the surgical care pathway race- and ethnicity-associated disparities emerge following primary transsphenoidal surgery (TSS) for Cushing's disease (CD).

Main Methods:

• Retrospective cohort study of 104 adult patients with pathologically confirmed CD undergoing primary TSS.
• Comparison of preoperative phenotype, perioperative complications, biochemical remission, radiographic persistence, and reintervention rates across White non-Hispanic (WnH), Hispanic, and Black patient groups.
• Sensitivity analysis using inverse probability of treatment weighting (IPTW) to adjust for baseline differences.

Main Results:

• Hispanic patients presented with milder disease, while Black patients had higher BMI and more solid tumors.
• Postoperative complications like arginine vasopressin deficiency were less frequent in Hispanic patients.
• Durable remission rates were similar across groups, but Black patients showed higher day-1 cortisol and delayed remission on IPTW; Black and Hispanic patients had higher reintervention rates.

Conclusions:

• Race- and ethnicity-associated differences in CD surgical care manifest primarily at baseline and in postoperative trajectory, not in durable biochemical remission.
• Findings suggest a need for postoperative surveillance strategies tailored to the specific points where disparities emerge.
• Further validation in larger, multicenter cohorts is required to confirm these hypothesis-generating findings.