Association of Facility Type With Procedural-Related Morbidities and Adverse Events Among Patients Undergoing Induced Abortions

Abstract

Is there an association between the type of facility in which an abortion is performed and abortion-related morbidities and adverse events? Findings: In this retrospective cohort study of 50311 induced abortions among 49287 women with private health insurance, performance of the abortion in an ambulatory surgery center, compared with an office-based setting, was not associated with a significant difference in abortion-related morbidities and adverse events (adjusted odds ratio, 0.97). Meaning: Rates of abortion-related morbidities and adverse events did not significantly differ by whether the abortion was performed in an ambulatory surgery center vs. an office-based setting.

Miscarriage Treatment–Related Morbidities and Adverse Events in Hospitals, Ambulatory Surgery Centers, and Office-Based Settings

“…ASCs and office-based settings. 11,12 Our estimates of miscarriage treatment-related events, including the more than 6% retained products of conception, are in the range of other estimates. [24][25][26][27][28][29][30][31] The rates of miscarriage treatment-related events are notably higher than published rates of abortion-related events.…”

“…The Truven Health database is a commercially available health insurance claims database often used in studies examining complications and follow-up care after health care procedures, including other gynecologic procedures. 12,14,15 It includes claims data for a sample of privately-insured people in all U.S. states, including demographic characteristics, health care utilization, dates of service, diagnosis codes, procedure codes, and facility type. The data represent claims from providers that have been adjudicated for payment and are obtained directly from a convenience sample of large employers and health plans that agree to participate in MarketScan.…”

“…[24][25][26][27][28][29][30][31] The rates of miscarriage treatment-related events are notably higher than published rates of abortion-related events. 9,10,12,32,33 One explanation is that there have been both government sponsored and professional association sponsored clinical quality improvement initiatives for abortion for more than 40 years, [33][34][35] meaning that considerable attention has been brought to ensuring and improving the safety of abortion care. This is important to emphasize, as many state laws require abortion -but not miscarriages or other procedures performed in outpatient settings -be performed in ASCs.…”

“…First, we used a national sample of claims data from a database often used to examine health care procedures safety. 12,14,15 Using this database allows a sufficiently large sample to detect differences, avoid biases associated with small samples, and control for potential confounders. Second, claims databases routinely capture health care visits and treatments that occur subsequent to the procedure, 10 which increases the likelihood that most events are captured and limits potential biases due to loss to follow-up.…”

“…9,10 A small body of research has compared safety of different procedures across ASCs and office-based settings and has not found consistent differences. 11,12 Research on safety of miscarriage treatment across facility types has been done primarily with small samples 5 and has not directly compared safety in two outpatient settings -ASCs v. office-based settings. The ASC vs.…”