Utilization of lymph node evaluation at hysterectomy for cervical carcinoma in situ.

Abstract

This study examined the utilization and characteristics of lymph node evaluation at hysterectomy for carcinoma in situ of the uterine cervix. This retrospective cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample, evaluating 7395 patients with cervical carcinoma in situ who underwent hysterectomy from 2016 to 2019. A multivariable binary logistic regression model was fitted to identify independent characteristics related to lymph node evaluation. A classification-tree was constructed with recursive partitioning analysis to examine utilization patterns of lymph node evaluation. Lymph node evaluation at hysterectomy was performed in 4.6%. In amultivariable analysis, older age, higher income, use of robotic-assisted hysterectomy, and surgery at large bed capacity or urban teaching centers in the northeast US region were associated with increased likelihood of lymph node evaluation (all, p < 0.05). Of those independent factors, robotic-assisted surgery exhibited the largest effect size (adjusted odds ratio 3.23, 95% confidence interval 2.54-4.10). Utilization pattern analysis identified nine unique characteristics, of which robotic-assisted surgery was the primary indicator for cohort allocation (12.4% vs. 3.2%, p < 0.001). The difference between the lowest-highest patterns was 33.3% (range, 0%-33.3%). Lymph node evaluation was rarely performed for cervical carcinoma in situ overall and robotic surgery was associated with increased utilization of lymph node evaluation.