8704 Evolving Referral Patterns and Management Following Implementation of a Multidisciplinary Fibroid Center

Abstract

<h3>Study Objective</h3> Evaluate referral patterns and management of symptomatic fibroids following implementation of a multidisciplinary (minimally invasive gynecologic surgery [MIGS] and interventional radiology [IR]) fibroid center. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Academic medical center in New York, NY. <h3>Patients or Participants</h3> Patients who presented for initial fibroid consultation between January-June 2019 and January-June 2021. Consult providers included general gynecologists (GYN), MIGS, IR and others. <h3>Interventions</h3> In September 2020, our institution established a multidisciplinary fibroid center where patients had same-day consults with both MIGS and IR providers. Data were collected before and after implementation of the program with regards to patient demographics, fibroid characteristics, prior imaging and management, referral patterns, and management after consultation. <h3>Measurements and Main Results</h3> 615 patients met inclusion criteria: 273 patients in 2019 and 342 patients in 2021. Patients seen in 2021 were more likely to have previously tried medical management (30.1% vs 20.2%, p<0.01) and many had no prior treatment (53.2% vs 61.5%, p=0.04). There were more MIGS (65.5% vs 53.1%) and fewer general GYN (19.0% vs 25.6%, p=0.02) consultations in 2021. More patients presented for an additional opinion in 2021 (83.6% vs 67.0%, p<0.01), predominately with MIGS (58.8% vs 37.0%, p<0.01). General GYNs were more likely to refer to MIGS (79.3% vs 73.1%) and IR (16.0% vs 13.0%, p=0.046) in 2021. There was increased utilization of MRI imaging in 2021 among MIGS (66.5% vs 52.4%, p<0.01). Among patients who saw MIGS for consultation in 2021, more underwent uterine artery embolization (UAE) (13.8% vs 6.9%, p=0.04) and fewer underwent diagnostic hysteroscopy/dilation and curettage (11.7% vs 4.5%, p<0.01) within 1 year of consultation. <h3>Conclusion</h3> Many patients with symptomatic fibroids seek specialist opinions regarding their treatment options. A multidisciplinary fibroid management program with coordinated efforts between MIGS and IR allows for comprehensive counseling and may lead to more efficient and timely care and an increase in minimally invasive procedures including UAE.