Women’s Health
Symptomatic Uterine Fibroids at an Academic Urban Safety Net Hospital Kendra Lujan* Kendra Lujan Julia C. Bond Ezinnem Ugoji Nyia L. Noel
Key Words: gynecology, healthcare utilization, fibroids, anemia
Introduction
We aimed to identify and characterize factors associated with repeat emergency department (ED) visits for symptomatic uterine leiomyomas (fibroids). Understanding factors associated with repeat ED visits can inform future clinical decision-making and interventions to improve patient care and reduce overall healthcare burden.
Methods
We performed a retrospective chart review of individuals aged 18-89 years presenting to the ED for uterine fibroids between June 2014 and February 2020. ED visits were identified by primary ICD-10 diagnosis, and the presence of pre-identified fibroid-related symptoms. We used generalized linear models to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for the association between patient and visit characteristics at initial ED visit and repeat ED visit prevalence.
Results
A total of 873 participants contributed 1036 ED visits. The mean encounter age was 48.5 (SD +/- 8.8) years. Most participants were Black or African American (76.5%), English-speaking (63.5%), and publicly insured (61.3%). Subjects were grouped number of ED visits: 1 (n = 750) and >1 visit (n = 123, 14%) Anemia diagnosis and iron transfusion therapy at the initial ED visit were positively associated with a repeat visit (PR 2.58, 95% CI 1.65, 4.27; PR 2.92, 95% CI 1.72, 4.40). Neither receiving an outpatient gynecology referral at initial visit, nor seeing a gynecologist for follow up within 2 weeks of initial visit, were appreciably associated with the prevalence of a repeat visit.
Discussion
Our analysis revealed that anemia status and the need for blood transfusion during an initial ED visit for fibroid was the strongest predictor of a repeat ED visit for fibroids. Providers should be aware of anemia as a particularly salient feature for patients presenting with uterine fibroids to the ED.