Emergency department visits increase for fibroids, while hospital admissions decrease

Emergency department (ED) visits in women affected by leiomyomas, or uterine fibroids (UFs), are increasing, but hospital admissions for this patient population are decreasing, according to a study published in the journal Obstetrics & Gynecology.

However, when women seek care for bleeding-related symptoms, the chance of admission increases. Location, age, and method of payment also factored into ED visits and admissions.

Erica E. Marsh, MD, MSCI, who is chief of the division of reproductive endocrinology and infertility at the Center for Reproductive Medicine at Michigan Medicine Von Voigtlander Women’s Hospital, conducted the study along with colleagues. Researchers were looking for national trends and associated charges by hospitals, in addition to identifying causes of hospital admissions.1

The authors used data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample database, the largest publicly available for all payers. They performed a retrospective examination of ED visits between 2006 and 2017 by women aged 18 to 55 years with a primary leiomyoma diagnosis as determined by ICD diagnosis codes.

Researchers also analyzed hospital charges, current procedural terminology codes, and secondary IDC diagnoses; they used a multivariate regression model to find admission predictors. “Gaining insight into the volume of these visits and drivers of admission could help redirect appropriate patients to alternative care settings, resulting in significant cost savings,” study authors wrote.1

Marsh and colleagues reported 533,963 ED visits for leiomyomas during the study period out of 487,688,338 total ED visits by women.1 Between 2006 and 2017, researchers said there was a 129% increase in ED visits for leiomyomas, from 28,732 to 65,685 visits.1

“The proportion of all ED visits that were for a primary diagnosis of leiomyomas also increased over the study period, from 0.079% in 2006 to 0.154% in 2017, suggesting that the increase was not simply from an increase in overall population volume,” researchers said. In contrast, admission rates fell from 23.9% in 2006 to 11.1% in 2017.1 Researchers noted that admission for all other diagnoses to the ED was only 8.5% during the study period.

Women aged 36 to 45 years accounted for 44.5% of ED and admissions for leiomyomas, while women aged 18 to 25 years had 3.4% of the share, according to the study. In addition, 36.1% of women coming to the ED were in the lowest income quartile, while women in the highest income quartile made up 16.4%.

Women from the geographic South were most likely to present to the ED (46.2%), while women from the Midwest (12.2%) were least likely. Private insurance was the most common payment method (38.3%), followed by Medicaid (27.1%) and self-pay (24.4%).

Researchers said uninsured patients were least likely to be admitted (Medicare: odds ratio [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).1

Marsh and colleagues said the decline in hospital admissions indicates that many ED visits for leiomyomas could be treated in non–acute care settings. They also noted that rates of admission varied greatly by location and method of payment, perhaps because of local policy or biases of health care professionals.

Bleeding was a strong factor in admissions, with the symptom presentation increasing admission odds 15-fold, according to the study.

“Improving our understanding of patients with leiomyomas who present to the ED, but are not admitted, will help target interventions to better care for these patients in the outpatient setting and ultimately reduce the burden of leiomyomas for both patients and society,” researchers said.

Reference

  1. Fortin CN, Jiang C, Caldwell MT, As-Sanie S, Dalton V, Marsh EE. Trends in emergency department utilization among women with leiomyomas in the United States. Obstet Gynecol. 2021;137(5):897-905. doi:10.1097/AOG.0000000000004333