Roberts SCM, et al. - In this retrospective cohort study, the researchers compared abortion-related morbidities and adverse events at ambulatory surgery centers (ASCs) vs office-based settings. They observed that performance of the abortion in an ambulatory surgical center compared with an office-based setting was not correlated with a significant difference in abortion-related morbidities and adverse events among women with private health insurance who had an induced abortion. The outcomes suggested that in addition to individual patient and individual facility factors, might inform decisions about the type of facility in which induced abortions were performed.

Methods

• Participants in the study were women with US private health insurance who underwent induced abortions in an ASC or office-based setting from January 1, 2011 to December 31, 2014.
• From a large national private insurance claims database, outcomes were abstracted during the 6 weeks following the abortion (date of final follow-up, February 11, 2015).
• Facility type for abortion (ASCs vs office-based settings, including facilities such as abortion clinics, nonspecialized clinics, and physician offices) was the main exposure.
• Any abortion-related morbidity or adverse event (such as retained products of conception, abortion-related infection, hemorrhage, and uterine perforation) within 6 weeks after an abortion was the primary outcome.
• Major abortion-related morbidities and adverse events (such as hemorrhages treated with a transfusion, missed ectopic pregnancies treated with surgery, and abortion-related infections that resulted in an overnight hospital admission) and abortion-related infections were two secondary outcomes, both subsets of the primary outcome.

Results

• According to the findings obtained, among 49,287 women (mean age, 28 years [SD, 7.3]) who had 50,311 induced abortions, (23,891 [47%] first-trimester aspiration, 13,480 [27%] first-trimester medication, and 12,940 [26%] second trimester or later), 5660 abortions (11%) were performed in ASCs and 44,651 (89%) in office-based settings.
• It was observed that 3.33% had an abortion-related morbidity or adverse event; 0.32% had a major abortion-related morbidity or adverse event; and 0.74% had an abortion-related infection.
• No statistically significant difference was found between ASCs vs office-based settings, respectively, in the rates of abortion-related morbidities or adverse events (3.25% vs 3.33%, difference, -0.8%; 95% CI, -0.58% to 0.43%; adjusted OR, 0.97; 95% CI, 0.81-1.17), major morbidities or adverse events (0.26% vs 0.33%; difference, -0.06%; 95% CI, -0.18% to 0.06%; adjusted OR, 0.78; 95% CI, 0.45-1.37), or infections (0.58% vs 0.77%; difference, -0.16%; 95% CI, -0.35% to 0.03%; adjusted OR, 0.75; 95% CI, 0.52-1.09) in adjusted analyses.