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National trends in inpatient endometriosis admissions: Patients, procedures and outcomes, 2006−2015


Autoři: Stephanie J. Estes aff001;  Ahmed M. Soliman aff002;  Andrew J. Epstein aff003;  Julia C. Bond aff003;  Keith Gordon aff002;  Stacey A. Missmer aff004
Působiště autorů: Department of Obstetrics and Gynecology, Penn State Health, Hershey, PA, United States of America aff001;  AbbVie Inc., North Chicago, IL, United States of America aff002;  Medicus Economics, Philadelphia, PA, United States of America aff003;  Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan, United States of America aff004;  Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222889

Souhrn

Introduction

Despite guidance towards minimally invasive, outpatient procedures for endometriosis, many patients nonetheless receive inpatient care. Our objective was to assess trends in patient and hospital characteristics, surgical complications and hospital charges for women with an endometriosis-related inpatient admission in the United States.

Methods

We conducted a pooled cross-sectional analysis of Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Visits were stratified into three time-period-defined cohorts (2006–2007, 2010–2011, and 2014 through the first three quarters of 2015). Visits were included if the patient was aged 18–49 years and the primary diagnosis code was for endometriosis (International Classification of Diseases, 9th Revision code 617.xx). We evaluated counts of inpatient admissions and rates of patient and hospital characteristics.

Results

The number of inpatient admissions with a primary diagnosis code for endometriosis decreased by 72.8% from 2006 to 2015. At the same time, among those admitted for inpatient care for endometriosis, the proportions who had Medicaid insurance and multiple documented comorbidities increased. From 2006 to 2015, mean total hospital charges increased by 75% to $39,662 in 2015 US dollars, although average length of stay increased by <1 day.

Conclusions

The number of inpatient admissions with a primary diagnosis of endometriosis decreased over the past decade, while surgical complications and associated hospital charges increased. The share of patients with multiple comorbidities increased and an increasing proportion of inpatient endometriosis admissions were covered by Medicaid and occurred at urban teaching hospitals. These findings suggest a demographic shift in patients receiving inpatient care for endometriosis towards more complex, vulnerable patients.

Klíčová slova:

Medicine and health sciences – Health care – Health care facilities – Hospitals – Patients – Surgical and invasive medical procedures – Outpatients – Inpatients – Surgical excision – Minimally invasive surgery – Reproductive system procedures – Laparoscopy – Hysterectomy


Zdroje

1. Giudice LC. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389–98. doi: 10.1056/NEJMcp1000274 20573927

2. Fuldeore MJ, Soliman AM. Prevalence and symptomatic burden of diagnosed endometriosis in the United States: national estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Inves 2017;82(5):453–61.

3. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gyn Clin N Am 1997;24(2):235–58.

4. Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol. 2004 Oct 15;160(8):784–96. doi: 10.1093/aje/kwh275 15466501

5. Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J, et al. Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertil Steril. 2011 Aug 1;96(2):360–5. doi: 10.1016/j.fertnstert.2011.05.087 21719000

6. Laganà AS, La Rosa VL, Rapisarda AMC, Valenti G, Sapia F. Chiofalo B. Anxiety and depression in patients with endometriosis: impact and management challenges. Int J Womens Health. 2017;9:323–330. doi: 10.2147/IJWH.S119729 28553145

7. Facchin F, Barbara G, Dridi D, Alberico D, Buggio L, Somigliana E, Saita E, Vercellini P. Mental health in women with endometriosis: searching for predictors of psychological distress. Hum Reprod. 2017;32(9):1855–1861. doi: 10.1093/humrep/dex249 28854724

8. Smorgick N, As-Sanie S. Pelvic pain in adolescents. Semin Reprod Med. 2018;36(2):116–122. doi: 10.1055/s-0038-1676088 30566977

9. Vitale SG, Capriglione S, Peterlunger I, La Rosa VL, Vitagliano A, Noventa M, et al. The role of oxidative stress and membrane transport systems during endometriosis: a fresh look at a busy corner. Oxid Med Cell Longev. 2018. https://doi.org/10.1155/2018/7924021.

10. Dordts S, Koninckx P, Brosens I. Pathogenesis of deep endometriosis. Fertil Steril. 2017;108(6):872–885. doi: 10.1016/j.fertnstert.2017.08.036 29100623

11. Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Vigano P. Endometriosis. Nat Rev Dis Primers. 2018;4(1):9. doi: 10.1038/s41572-018-0008-5 30026507

12. Falcone T, Flyckt R. Clinical management of endometriosis. Obstet Gynecol 2018;131(3):557–71. doi: 10.1097/AOG.0000000000002469 29420391

13. Gambone JC, Mittman BS, Munro MG, Scialli AR, Winkel CA, Chronic Pelvic Pain/Endometriosis Working Group. Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process. Fertil Steril. 2002 Nov 1;78(5):961–72. doi: 10.1016/s0015-0282(02)04216-4 12413979

14. Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 Mar 1; 29(3):400–12. doi: 10.1093/humrep/det457 24435778

15. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012 Sep 1;98(3):591–98. doi: 10.1016/j.fertnstert.2012.05.031 22704630

16. Vercellini P, Frattaruolo MP, Buggio L. Toward minimally disruptive management of symptomatic endometriosis: reducing low-value care and the burden of treatment. Expert Rev Pharm Out. 2018 Dec 6;18(1):1–4.

17. National Institute for Health Care Excellence. Endometriosis: diagnosis and management [Internet]; 2017 [cited 2019 May 9]. Available from: https://www.nice.org.uk/guidance/ng73/chapter/Recommendations#surgical-management.

18. Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990–1997. Obstet Gynecol. 2002 Feb 1;99(2):229–34. doi: 10.1016/s0029-7844(01)01723-9 11814502

19. Lee J, Jennings K, Borahay MA, Rodriguez AM, Kilic GS, Snyder RR, et al. Trends in the national distribution of laparoscopic hysterectomies from 2003 to 2010. J Minim Invas Gyn. 2014 Jul 1;21(4):656–61.

20. Morgan DM. Kamdar NS, Swenson CW, Kobernik EK, Sammarco AG, Nallamothu B. Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women. Am J Obstet Gynecol. 2018 Apr 1; 218(4):425–e1. doi: 10.1016/j.ajog.2017.12.218 29288067

21. Alexander AL, Strohl AE, Rieder S, Holl J, Barber EL. 2019. Examining disparities in route of surgery and postoperative complications in black race and hysterectomy. Obstet Gynecol. 2019 Jan 1;133(1):6–12. doi: 10.1097/AOG.0000000000002990 30531569

22. Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis. Eur J Obstet Gyn R B. 2009 May 1;144(1):3–7.

23. HCUP Databases. Healthcare Cost and Utilization Project (HCUP) [Internet]. August 2018. Rockville, MD: US Agency for Health Care Research and Quality [cited May 9, 2019]. Available from: www.hcup-us.ahrq.gov/nisoverview.jsp.

24. Houchens R, Ross D, Elixhauser A, Jiang J. Nationwide Inpatient Sample (NIS) Redesign Final Report. 2014. HCUP Methods Series Report # 2014–04 ONLINE. April 4, 2014. Rockville, MD: US Agency for Health Care Research and Quality [cited May 9, 2019]. Available from: https://www.hcup-us.ahrq.gov/reports/methods/2014-04.pdf.

25. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1)8–27. doi: 10.1097/00005650-199801000-00004 9431328

26. Using appropriate price indices for analyses of health care expenditures or income across multiple years. Rockville, MD: US Agency for Health Care Research and Quality [cited May 9, 2019]. Available from: https://meps.ahrq.gov/about_meps/Price_Index.shtml.

27. Houchens RL, Ross D, Elixhauser A. Using the HCUP National Inpatient Sample to Estimate Trends. 2015. HCUP Methods Series Report # 2006–05 ONLINE. January 4, 2016. Rockville, MD: US Agency for Health Care Research and Quality [cited May 9, 2019]. Available from: https://www.hcup-us.ahrq.gov/reports/methods/2006_05_NISTrendsReport_1988-2004.pdf.

28. Howard BV, Kuller L, Langer R, Manson JE, Allen C, Assaf A, et al. Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy: The Women’s Health Initiative Observational Study. Circulation. 2005 Mar 29;111(12)1462–70. doi: 10.1161/01.CIR.0000159344.21672.FD 15781742

29. Cohen SL, Vitonis AF, Einarsson JI. Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy. JSLS-J Soc Laparoend 2014 Jul;18(3): e2014.00096.

30. Rizk B, Fischer AS, Lotfy HA, Turki R, Zahed HA, Malik R, et al. Recurrence of endometriosis after hysterectomy. Facts Views Vis Obgyn. 2014;6(4)219–27. 25593697

31. Steiner CA, Barrett ML, Weiss AJ, Andrews RM. Trends and projections in hospital stays for adults with multiple chronic conditions, 2003–2014. HCUP Statistical Brief #183. Rockville, MD: Agency for Health Care Research and Quality [cited May 9, 2019]. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb183-Hospitalizations-Multiple-Chronic-Conditions-Projections-2014.pdf.

32. Surrey ES Soliman AM, Yang H, Du EX, Su B. Treatment patterns, complications and health care utilization among endometriosis patients undergoing a laparoscopy or a hysterectomy: a retrospective claims analysis. Adv Ther. 2017 Nov 1;34(11):2436–2451. doi: 10.1007/s12325-017-0619-3 29039055

33. Soliman AM, Du EX, Yang H, Wu EQ, Haley JC. Retreatment rates among endometriosis patients undergoing hysterectomy or laparoscopy. J Womens Health. 2017 Jun 1;26(6):644–54.

34. Soliman AM, Taylor H, Bonafede M, Nelson JK, Castelli-Haley J. Incremental direct and indirect cost burden attributed to endometriosis surgeries in the United States. Fertil Steril. 2017 May 1;107(5):1181–1190. doi: 10.1016/j.fertnstert.2017.03.020 28476181

35. Gao X, Outley J, Botteman M, Spalding J, Simon JA, Pashos CL. Economic burden of endometriosis. Fertil Steril. 2006 Dec 1;86(6):1561–72. doi: 10.1016/j.fertnstert.2006.06.015 17056043

36. Elixhauser A, Heslin KC, Owens PL. Healthcare Cost and Utilization Project (HCUP) Recommendations for Reporting Trends Using ICD-9-CM and ICD-10-CM/PCS Data. ONLINE. Revised July 5, 2017. Rockville, MD: US Agency for Health Care Research and Quality [cited May 9, 2019]. Available from: https://www.hcup-us.ahrq.gov/datainnovations/HCUP_RecomForReportingTrends_070517.pdf. Retrieved April 5, 2019.

37. Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod. 2017 Jan 23;32(2):315–24. doi: 10.1093/humrep/dew293 27920089

38. Raffaelli R, Garzon S, Baggio S, Genna M, Pomini P, Lagana AS, et al. Mesenteric vascular and nerve sparing surgery in laparoscopic segmental intestinal resection for deep infiltrating endometriosis. Eur J Obstet Gynecol Reprod Biol. 2018;221:214–219.

39. Laganà AS, Vitale SG, Trovato MA, Palmara VI, Rapisarda AM, Granese R, et al. Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: rationale and potential treatment options.Biomed Res Int. 2016. http://dx.doi.org/10.1155/2016/3617179.

40. Abo C, Moatassim S, Marty N, Saint Ghislain M, Huet E, Bridoux V, et al. Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases. Fertil Steril. 2018;109(1):172–8. doi: 10.1016/j.fertnstert.2017.10.001 29307394

41. Nisolle M, Brichant G, Tebache L. Choosing the right technique for deep endometriosis. Best Pract Res Clin Obstet Gynaecol. 2019;pii: S1521-6934(18)30241-4. doi: 10.1016/j.bpobgyn.2019.01.010 30824210

42. HCUPnet. Healthcare Cost and Utilization Project. Rockville MD: US Agency for Healthcare Research and Quality [cited May 9, 2019]. Available from: https://hcupnet.ahrq.gov.

43. Rehmer JM, Flyckt RL, Goodman LR, Falcone T. Management of Endometriomas. Obstet Gynecol Surv. 2019;74(4):232–240. doi: 10.1097/OGX.0000000000000660 31344251


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