Abortion-Related Adverse Events by Facility Type

Abstract

In this issue of JAMA, Roberts and colleagues 1 report findings from their analysis of abortion-related adverse event rates stratified by facility type. The authors used 2011-2014 data from Truven, a health insurance claims database covering a sample of privately insured people in all 50 states, to compare the rate of additional abortion-related claims within 60 days of the abortion among women who had abortions in office-based settings (including facilities such as abortion clinics, nonspecialized clinics, and physician offices) vs claims among women who had abortions in ambulatory surgery centers (ASCs). The study sample included 49 287 patients who had 50 311 abortions, of which 27% were first-trimester medication abortions, 47% were firsttrimester procedures, and 26% were second-trimester or later procedures. Of the abortions, 89% took place in an office setting, and 11% took place in an ASC.Overall, 3.33% of these abortions were followed by an abortion-related morbidity or adverse event (such as retained products of conception, abortion-related infection, hemorrhage, and uterine perforation); of these, 0.32% were followed by a major adverse event (such as hemorrhage treated with transfusion, missed ectopic pregnancy treated with surgery, and abortion-related infections that resulted in hospital admission), and 0.74% were followed by an abortion-related infection. The database included variables to allow adjustment for chronic health conditions and health care utilization patterns during the previous year. In adjusted analyses, there were no significant differences in the rates of adverse outcomes between office and ASC settings in overall rates of adverse events (3.33% vs 3.25%, respectively) or rates of major adverse events (0.33% vs 0.26%, respectively). No deaths were reported among women who met criteria for inclusion in the study cohort.The study by Roberts et al has several strengths, including the ability to adjust for health and other variables (age, region), and the use of a priori definitions of abortion-related morbidities and adverse events that had been tested in an earlier study. 2,3 The adverse event rates reported are comparable with previous reports from the United States, 4,5 which supports the validity of these analyses. The information on adverse events by abortion setting is novel, as previous studies of abortion safety have not compared facility types. Moreover, the finding of no deaths in the study cohort is consistent with data from other reports; the abortion-associated rate in the United States is less than 1 death per 100 000