59. IUD Insertion in Out-of-OR Sedation Clinic in the Adolescent Population

Background

Hormonal Intrauterine Devices (IUDs) are important contraceptives and treatment for adolescent menstrual disorders. However, uptake may be limited in adolescents in the clinic setting for concerns that it may be painful and anxiety-provoking. Pediatric and Adolescent Gynecology at SickKids Hospital offers IUD insertion under anesthetic in the operating room (OR) but wait times are long. The primary goal of this study is to assess the implementation of an out-of-OR sedation program for IUD insertion on wait times. Secondary goals are to assess if a sedation program increases the likelihood of selecting an IUD, reduces anxiety and provides a positive insertion experience.

Methods

This is a retrospective review of IUD insertions in a tertiary institution in 3 settings: clinic, OR and a sedation clinic. OR cases occurred between June 2022 - June 2023, and sedation cases from June 2023 - June 2024. Wait times (days) were calculated from booking date to procedure date. Data was extracted from the electronic medical record. Patients under age 18 seeking IUD insertion were included. Exclusion criteria for sedation were BMI ≥30 due to anaesthetic limitations, severe developmental disability, and patients consented before roll out of sedation (June 2023). A brief survey is in progress for the sedation and clinic setting, to assess patient experience. Quality Improvement approval was obtained through SickKids Hospital. Descriptive statistics were used to summarize patient characteristics, with p-values ≤0.05 statistically significant. Analysis was performed using SPSS Statistics software.

Results

83 patients met inclusion criteria, (N=9 clinic, N=37 OR, and N=37 sedation). There were significant differences between BMI, age, and sexual history for each setting. Due to anaesthetic protocols, BMI in the clinic and the OR was higher than in sedation (p = 0.007). Patients were older in the sedation group (M = 16.05) compared to the OR (M = 15.35), (p =0.044). Most patients in clinic (88.9%) were sexually active, higher compared to OR and sedation (p< 0.001). Procedure wait time was lower in sedation (M = 66.05 days) compared to the OR (M =172.00 days), (p< 0.001). There was no difference in diagnosis for OR vs sedation in terms of menstrual indications for IUD insertion. Primary sedatives were ketamine and midazolam for sedation (97%), and propofol and dexmedetomidine for OR (41%). Complication rates and comorbidities were similar between groups. Survey results are pending.

Conclusions

The sedation program significantly improves access to care with shorter wait times. This supports broader adoption of sedation programs to enhance gynecologic care for adolescents.