Division of Reproductive Endocrinology and Infertility and the Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, and the Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan.
Obstet Gynecol. 2021 May 1;137(5):897-905. doi: 10.1097/AOG.0000000000004333.
To describe trends in emergency department (ED) visits in the United States with a primary diagnosis of leiomyomas, subsequent admissions, and associated charges.
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.
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).
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.
描述美国以子宫肌瘤为主要诊断的急诊科就诊、随后入院和相关费用的趋势。
使用医疗保健成本和利用项目全国急诊科抽样数据库，回顾性确定 2006 年至 2017 年间年龄在 18-55 岁之间、主要诊断为子宫肌瘤的女性的所有急诊科就诊情况，这些女性的子宫肌瘤由国际疾病分类（ICD）诊断代码表明。分析了患者和医院特征的急诊科就诊和随后入院的趋势，并进行了分层。分析了次要 ICD 代码、当前程序术语代码和医院费用。使用多元回归模型确定入院的预测因素。
尽管子宫肌瘤的急诊科就诊人数从 2006 年的 28732 例增加到 2017 年的 65685 例，但入院率却从 2006 年的 23.9%下降到 2017 年的 11.1%。36-45 岁的女性（44.5%）、收入最低的四分之一（36.1%）、私人保险（38.3%）和居住在南部（46.2%）的女性子宫肌瘤急诊科就诊率最高。在非教学医院（优势比[OR]1.23，95%置信区间[CI]1.08-1.39）或位于东北部的医院（OR 1.39，95%CI 1.15-1.68）入院的可能性更大。与入院相关的患者特征包括年龄较大（26-35 岁：OR 1.42，95%CI 1.21-1.66；36-45 岁：OR 2.01，95%CI 1.72-2.34；46-55 岁：OR 2.60，95%CI 2.23-3.03）和出血相关的投诉（OR 14.92，95%CI 14.00-15.90）。无保险患者入院的可能性最低（医疗保险：OR 1.37，95%CI 1.21-1.54；医疗补助：OR 1.26，95%CI 1.16-1.36；私人：OR 1.44，95%CI 1.32-1.56）。
尽管子宫肌瘤的急诊科就诊人数正在增加，但这些就诊的入院率却在下降。入院率的大幅下降表明，这些就诊中有很大一部分可能可以在非急性护理环境中得到解决。然而，当患有子宫肌瘤的女性出现与出血相关的投诉时，入院的可能性会增加 15 倍。基于保险类型，入院的可能性存在明显差异。
