8452 Lymph Node Evaluation for Endometrial Hyperplasia: A National Level Analysis of Minimally Invasive Hysterectomy in the Ambulatory Setting

Abstract

<h3>Study Objective</h3> To examine the association between histology and utilization of lymph node evaluation at the time of minimally invasive hysterectomy when performed for endometrial hyperplasia in an ambulatory surgery setting. <h3>Design</h3> Population-based, retrospective cohort study. <h3>Setting</h3> The National Ambulatory Surgery Sample, 2016-2019. <h3>Patients or Participants</h3> 39,205 patients with endometrial hyperplasia who underwent minimally invasive hysterectomy (total laparoscopic, laparoscopic assisted vaginal, and total vaginal), including 19,653 cases with atypia and 19,552 cases without atypia. Patients with invasive uterine, cervical, and ovarian cancers were excluded. <h3>Interventions</h3> <i>(i)</i> Multivariable analysis with log-Poisson generalized linear regression model to compare the clinical characteristics between the atypia and non-atypia groups, and <i>(ii)</i> inverse probability of treatment weighting to assess the utilization of lymph node evaluation at the time of hysterectomy, stratified by histology type. <h3>Measurements and Main Results</h3> In a multivariable analysis, patients in the atypia group were more likely to have older ages, obesity, medical comorbidities, a recent diagnosis, self-paid insurance, higher household incomes, and undergo surgery at large, urban teaching centers compared to those in the non-atypia group (all, <i>P</i><0.05). Patients in the atypia group were less likely to undergo laparoscopic assisted vaginal or total vaginal hysterectomy compared to those in the non-atypia group (both, <i>P</i><0.05). In a propensity score-weighted model, patients in the atypia group were more likely to have lymph node evaluation at the time of hysterectomy compared to those in the non-atypia group (8.8% <i>versus</i> 2.8%, odds ratio 3.37, 95% confidence interval 3.02-3.77). <h3>Conclusion</h3> This national-level analysis suggests that lymph node evaluation was performed at the time of minimally invasive hysterectomy for endometrial hyperplasia in the ambulatory surgery setting in the United States from 2016-2019. Surgeons appear to evaluate lymph nodes more frequently for endometrial hyperplasia with atypia than without.