SIR 2024
Women's Health
Nicole H. Kim, BA
Medical Student
Harvard Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
Julie C. Bulman, MD
Interventional Radiologist
Beth Israel Deaconess Medical Center, Harvard Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
Muhammad Mohid Tahir, MD (he/him/his)
Postdoctoral Research Fellow
Beth Israel Deaconess Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Razan Ali, BS
Medical Student
Elson S. Floyd College of Medicine
Disclosure information not submitted.
Ammar Sarwar, MD, FSIR (he/him/his)
Associate Professor of Radiology
Harvard Medical School / Beth Israel Deaconess Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Post-embolization syndrome is the most frequent indication for post-procedure hospitalization after elective uterine artery embolization (UAE); however, there are no published identifiable risk factors for readmissions after UAE. The aim of this study was to identify risk factors for readmissions following UAE for fibroids or adenomyosis.
Materials and methods:
A retrospective review of 246 female patients (age: 46±5 years) who underwent elective UAE for fibroids or adenomyosis at a large urban tertiary academic center between January 2018 and December 2022 was conducted. Medical Image Merge (MIM Software Inc., Cleveland, OH) contouring software was used to calculate uterine volumes using pre-procedure MRI. Total opioid requirements were calculated by summing oral morphine milligram equivalents administered during outpatient status periprocedural care. Univariate analyses using t-tests and z-tests were conducted to identify variables associated with readmissions within 30 days of discharge, including subgroup analysis among patients who received technically successful superior hypogastric nerve block (SHNB).
Results:
Of 246 total cases, 125 (51%) included SHNB, and the overall rate of 30-day readmissions was 13%. Readmission rates among SHNB and no SHNB patients were 17% and 9%, respectively. In readmitted patients compared to those without readmissions, higher total periprocedural opioid requirements were significantly associated with 30-day readmission (80 vs 70 mg, p=.026); no association was found for BMI (30 vs 31, p=.44), uterine volume (858 vs 732 cc, p=.35), total vials of trisacryl gelatin particles (7 vs 6 vials, p=.70), or SHNB administration (66 vs 49%, p=.11). Among SHNB patients, readmitted patients were found to have lower BMI compared to those without readmissions (28 vs 32, p=.033), while no association was found for total opioid requirements (76 vs 75 mg, p=.86), uterine volume (977 vs 746, p=.21), or total vials of trisacryl gelatin particles (8 vs 6 vials, p=.38).
Conclusion:
Higher periprocedural total opioid requirements were associated with 30-day readmission after UAE for all-comers, suggesting periprocedural pain response may parallel future likelihood of readmission. However, in patients undergoing SHNB, there were no specific indicators for readmission. Periprocedural pain management strategies influence readmissions more than underlying fibroid burden; additional studies to elucidate this effect are warranted.