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

Abstract

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.

Early Pregnancy Loss Management in the Emergency Department vs Outpatient Setting

“…The primary exposure of interest was location of service (ED vs outpatient setting). Location of service was determined by the MarketScan place-of-service code variable (stdplac) coded as either 23 (emergency room) or 11 (office), and other locations of service were not included …”

“…Finally, we used the Elixhauser Comorbidity Index to control for comorbidities . We used a binary score of 1 or more of 30 comorbidities listed in the Elixhauser index . All covariates included in regression analyses were selected a priori on the basis of prior knowledge and clinical relevance.…”

“…Location of service was determined by the MarketScan place-of-service code variable (stdplac) coded as either 23 (emergency room) or 11 (office), and other locations of service were not included. 19 Additional variables or covariates of interest included age (in years), insurance policy status (primary policy holder or spouse vs dependent), metropolitan statistical area status (rural vs urban location), geographic region (West, Northeast, North-Central, and South), type of insurance plan (health maintenance organization, preferred provider organization, exclusive provider organization, or other), and year of index EPL diagnosis. We examined whether patients had received prenatal care before their EPL diagnosis and whether they had a prior diagnosis of threatened EPL in the current pregnancy.…”

What organisational and regional factors influence the outpatient provision of curettages in Germany? A longitudinal secondary data analysis using hospital quality reports data from 2013 to 2019

“…Advances in anaesthesia as well as surgical methods have made this possible; however, this is also due to patients’ desires 1 2. Outpatient implementation of surgical procedures offers numerous advantages and is superior to inpatient performance in safety, efficiency and resource savings;3 4 furthermore, fewer specialists (especially overnight staff) are occupied in caring for patients who undergo outpatient surgery 5. This can be particularly advantageous during shortages of nursing and medical staff.…”

Analysis of Patient Safety Culture at Semen Padang Hospital Indonesia

“…A strong patient safety culture can also reduce the risk of lawsuits that can create additional costs for the hospital or healthcare system. By focusing on patient safety and providing high-quality care, the risk of potential lawsuits can be reduced [18][19][20].…”