Outcomes of Endometrial Ablation in Patients With Very High Body Mass Index [ID 1137]

INTRODUCTION: Endometrial ablation (EA) failure occurs when a patient requires repeat EA or hysterectomy. Obese patients have a slightly increased risk of EA failure. Providers may withhold EA from patients with a very high body mass index (BMI) due to a presumed trend of increasing EA failure with increasing BMI. We sought to evaluate this trend to enable providers to better select ideal candidates for EA. METHODS: An IRB-approved retrospective cohort study was conducted, which included patients who underwent EA between 2006 and 2018 and with minimum 5-year follow-up within our health system. Patients were grouped by BMI class, and the EA failure rate for each class was calculated. A Cochran–Armitage test of trend was performed to evaluate for significance with alpha = 0.05. Pathology reports from hysterectomies that followed EA were reviewed. RESULTS: We identified 3,398 patients. Endometrial ablation failure rates by BMI category were 20.0% (normal), 23.3% (overweight), 21.2% (class I), 24.3% (class II), 24.2% (class III), and 18.3% (BMI greater than 50), with P =.24 for the trend. A total of 926 pathology reports were reviewed, and seven patients had a uterine malignancy. CONCLUSIONS/IMPLICATIONS: We demonstrated no trend towards increased EA failure with increasing BMI. Strengths include a large sample size, especially of patients with a very high BMI, and a high rate of follow-up within our system. Limitations include the retrospective nature of the study and data from a single system. These findings suggest providers should not be discouraged from offering EA to patients with very high BMI.