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Emergency department utilization by patients with gynecologic cancer in the United States
  1. Benjamin B Albright1,2,
  2. Mucio K Delgado3,
  3. Nawar A Latif1,
  4. Robert L Giuntoli1,
  5. Emily M Ko1 and
  6. Ashley F Haggerty1
  1. 1 Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
  2. 2 Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
  3. 3 Center for Emergency Care Policy and Research, Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Benjamin B Albright, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA; benjamin.albright{at}


Introduction Payment reform will give oncologists increasing responsibility for how patients with cancer meet unexpected care needs.

Objective To differentiate how patients with gynecologic cancers use emergency care, and to assess the characteristics associated with potentially avoidable treat-and-release visits.

Methods We performed a retrospective cohort study using the Nationwide Emergency Department Sample, a stratified sample of visits in United States hospital-based emergency departments, from 2010 to 2014. Visits by patients with a diagnosis of gynecologic cancer were selected. Sample weights were applied to calculate national estimates of care patterns and trends. Associations with treat-and-release disposition were assessed with weighted logistic regression.

Results In the study period, patients with gynecologic cancer made an estimated 370 104 annual emergency department visits (95% CI 351 997 to 388 211). A total of 50.2% of patients were treated and released, 48% were admitted, 1.6% were transferred, and 0.1% died. These visits corresponded to over US$1.27 billion in annual charges, with an average charge of US$3428 per visit (95% CI 3348 to 3509). Driven by growing treat-and-release utilization, annual visits increased, while admission rates fell over time. Patients with cervical cancer represented the plurality (36%) of visits; they were relatively younger, of lower socioeconomic status, and had fewer co-morbidities. Models for treat-and-release disposition did not vary significantly across different cancer populations. In the all-cancer model, increased odds of treat-and-release disposition was associated with cervical cancer diagnosis, younger age, lesser Elixhauser co-morbidity, Medicare coverage (OR=1.19; p<0.001), Medicaid coverage (OR=1.25; p<0.001), uninsured status (OR=1.70; p<0.001), and weekend visits. Visits in the northeast, at urban hospitals, and in winter months showed decreased odds of treat-and-release disposition.

Discussion Patients with gynecologic cancers have been using the emergency department at increasing rates, primarily driven by treat-and-release visits that did not result in admission or death. Patients with cervical cancer have higher rates of treat-and-release utilization and may over-use emergency department care.

  • ovarian cancer
  • cervical cancer
  • vulvar and vaginal cancer
  • uterine cancer
  • postoperative complications

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  • Contributors All authors: Study conception, analysis planning, and manuscript revisions. BBA: Primary data analysis and manuscript drafting.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The Nationwide Emergency Department Sample is available for purchase from the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.