Trends in emergency department visits for pelvic organ prolapse in the United States

Objectives: Data is limited on the burden to the emergency department for patients who present with non-urgent urogynecologic conditions. We attempted to evaluate the population utilizing the emergency department for non-postoperative pelvic organ prolapse concerns.

Methods: We performed a cross-sectional study of the 2018 Healthcare Cost and Utilization Project Nationwide Emergency Department (ED) Database, which samples ED visits for 995 hospitals in 40 states and the District of Columbia, approximating a 20-percent stratified sample of U.S. hospital-owned EDs. We identified female adult patients with a primary diagnosis of pelvic organ prolapse via ICD-10-CM codes. Concurrent urogynecologic diagnoses and secondary diagnoses were identified by ICD-10-CM codes. Descriptive analysis was performed with SAS.

Results: We identified 3638 non-postoperative emergency department encounters for pelvic organ prolapse out of 28 million emergency department visits in 2018 (< 0.01%). A majority of presentations were for uterovaginal prolapse (45.8%) followed by cystocele (38.7%). Urinary tract infection was the most frequent concurrent urogynecologic diagnosis (9.0%), while hypertension was the most common non-urogynecologic secondary diagnosis (14.5%). Most patients were between 65 and 79 years old (30.7%), though similar frequencies of patients < 50 years old (27.2%) and 50 to 64 years old (28.0%) were observed.



A majority of patients presenting to the emergency department for pelvic organ prolapse had an average household income in the 0 to 25^th percentile (34.9%) and were Medicare recipients (42.5%). Emergency department encounters largely took place in private (68.6%), urban teaching hospitals (61.8%) which were not affiliated with trauma centers (49.8%). Most encounters geographically took place in the South (37.2%).



A majority of patients (91.3%) were discharged from the emergency department; however, 6.3% were admitted to the hospital and 1.7% were transferred to another facility.

Conclusions: Emergency department visits for non-urgent pelvic organ prolapse disproportionately affect patients of low socioeconomic status. Though less than 0.01% of emergency department visits are for non-postoperative pelvic organ prolapse concerns, 8.0% of these encounters result in admission or transfer to another facility for appropriate care. Education efforts administered to patients and emergency department providers may mitigate the overuse of emergency department resources for pelvic organ prolapse.