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

Roberts, Sarah C. M.; Upadhyay, Ushma D.; Liu, Guodong; Kerns, Jennifer L.; Ba, Djibril M.; Beam, Nancy; Leslie, Douglas L.

doi:10.1001/jama.2018.7675

Cited by 37 publications

(25 citation statements)

References 30 publications

(66 reference statements)

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“…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.…”

Section: Methodsmentioning

confidence: 99%

“… 5 , 7 , 9 , 10 , 23 That we did not observe consistent differences in safety across ASCs and office-based settings is consistent with the small literature that compares safety of outpatient procedures across ASCs and office-based settings. 11 , 12 …”

Section: Commentmentioning

confidence: 99%

“…24 – 31 The rates of miscarriage treatment–related events are notably higher than published rates of abortion-related events. 9 , 10 , 12 , 32 , 33 One possible 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 – 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.…”

Section: Commentmentioning

confidence: 99%

“…First, we used a national sample of claims data from a database often used to examine safety of health care procedures. 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.…”

Section: Commentmentioning

confidence: 99%

“… 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 …”

mentioning

confidence: 99%

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

et al. 2018

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Objective: To examine whether miscarriage treatment-related morbidities and adverse events vary across facility types. Methods: A retrospective cohort study compared miscarriage treatmentrelated morbidities and adverse events across hospitals, ambulatory surgery centers (ASCs), and office-based settings. Data on women who had miscarriage treatment between 2011-2014 and were continuously enrolled in their insurance plan for at least one year prior to and at least six weeks after treatment were obtained from a large national private insurance claims database. The main outcome was miscarriage treatment-related morbidities and adverse events occurring within six-weeks of miscarriage treatment. Secondary outcomes were major events and infections. Results: 97,374 miscarriage treatments met inclusion criteria. Most (75%) were provided in hospitals, 10% ASCs, and 15% office-based settings. 9.3% had miscarriage treatment-related events, 1.0% major events, and 1.5% infections. In adjusted analyses, there were fewer events in ASCs (6.5%) than office-based settings (9.4%) and hospitals (9.6%), but no significant difference between office-based settings and hospitals. There were no significant differences in major events between ASCs (0.7%) and office-based settings (0.8%), but more in hospitals (1.1%) than ASCs and office-based settings. There were fewer infections in ASCs (0.9%) than office-based settings (1.2%) and more in hospitals (1.6%) than ASCs and office-based settings. In analyses stratified by miscarriage treatment type, the difference 45 46 3 between ASCs and office-based settings was no longer significant for miscarriages treated with procedures. Conclusions: While there appear to be slightly more events in hospitals than ASCs or office-based settings, findings do not support limiting miscarriage treatment to particular settings.

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Section: Methodsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

“… 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 …”

mentioning

confidence: 99%

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

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Abortion-Related Adverse Events by Facility Type

Westhoff

Davis

2018

JAMA

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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

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Data Error

2018

JAMA

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

Cited by 37 publications

References 30 publications

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

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

Abortion-Related Adverse Events by Facility Type

Data Error

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