Trends in Emergency Department Utilization Among Women With Leiomyomas in the United States
Fortin CN, Jiang C, Caldwell MT, As-Sanie S, Dalton V, and Marsh EE. Trends in Emergency Department Utilization Among Women With Leiomyomas in the United States. Obstet Gynecol 2021; 137(5):897-905.
Obstetrics and gynecology
OBJECTIVE: To describe trends in emergency department (ED) visits in the United States with a primary diagnosis of leiomyomas, subsequent admissions, and associated charges.
METHODS: The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database was used to retrospectively identify all ED visits from 2006 to 2017 among women aged 18-55 years with a primary diagnosis of leiomyomas as indicated by International Classification of Diseases (ICD) diagnosis codes. Trends in ED visits and subsequent admissions were analyzed and stratified by patient and hospital characteristics. Secondary ICD codes, Current Procedural Terminology codes, and hospital charges were analyzed. A multivariate regression model was used to identify predictors of admission.
RESULTS: Although the number of ED visits for leiomyomas increased from 28,732 in 2006 to 65,685 in 2017, the admission rate decreased, from 23.9% in 2006 to 11.1% in 2017. Emergency department visits for leiomyomas were highest among women who were aged 36-45 years (44.5%), in the lowest income quartile (36.1%), privately insured (38.3%), and living in the South (46.2%). Admission was more likely at nonteaching hospitals (odds ratio [OR] 1.23, 95% CI 1.08-1.39) or those located in the Northeast (OR 1.39, 95% CI 1.15-1.68). Patient characteristics associated with admission included older age (26-35 years: OR 1.42, 95% CI 1.21-1.66; 36-45 years: OR 2.01, 95% CI 1.72-2.34; 46-55 years: OR 2.60, 95% CI 2.23-3.03) and bleeding-related complaints (OR 14.92, 95% CI 14.00-15.90). Admission was least likely in uninsured patients (Medicare: OR 1.37, 95% CI 1.21-1.54; Medicaid: OR 1.26, 95% CI 1.16-1.36; private: OR 1.44, 95% CI 1.32-1.56).
CONCLUSION: Although ED visits for leiomyomas are increasing, admission rates for these visits are decreasing. The substantial decline in admissions suggests many of these visits could potentially be addressed in a non-acute-care setting. However, when women with leiomyomas present with a bleeding-related complaint, the odds of admission increase 15-fold. There is an apparent disparity in likelihood of admission based on insurance type.