Ambulatory surgery center and office-based setting results in similar outcomes for abortion

1. In this retrospective cohort study, there were no significant differences in abortion-related morbidity when the procedure occurred in an ambulatory surgical center (ASC) versus an office-based setting.

2. When substratified for first-trimester, medication-induced abortions, adverse events were significantly more common in ASCs as compared to office-based settings.

Evidence Rating: 2 (Good)

Study Rundown: In certain U.S. states, abortions have laws that require the procedure to be administered in ambulatory surgery centers (ASCs); however, approximately 95% of induced abortions occur in non-ASC locations. Despite these laws, there has been little evidence that demonstrates that ASCs improve patient outcomes versus office-based settings. Using private insurance claims, this study showed that there were no differences in abortion-related morbidity or adverse events in abortion procedures performed in an ASC versus an office-based setting. However, for first-trimester, medication induced abortions, there were significantly more adverse events when performed in an ASC as compared to office-based settings. For second trimester or later abortions there were also no differences found in abortion-related morbidity between ASCs versus office-based settings.

In all, these results suggest that these two setting are largely equivalent for performing abortions, though some limitations exist. In particular, these findings may not be generalizable to all abortions performed in the US, as these were all privately insured patients, whereas 85% of the almost 1 million abortions performed each year are not funded by private insurers.

Click to read the study, published in JAMA

Relevant Reading: Abortion Incidence and Service Availability In the United States, 2014

In-Depth [retrospective cohort]: The study cohort included 49 297 patients who underwent 50 311 abortions between January 1, 2011 and December 31, 2014 in either an ASC or an office-based setting, with 5660 (11%) abortions occurred in an ASC and 44 651 (89%) occurred in an office-based setting. The primary outcome was abortion-related morbidity (retained products of conception, uterine perforation, disseminated intravascular coagulation, missed ectopic pregnancy, etc.) and adverse events while the secondary outcomes were major abortion-related morbidities (blood transfusion, additional surgery, or overnight hospital stay) and adverse events as well as abortion-related infections. Patients were included if they were 11 years of age or older, were enrolled in their private insurance plan for at least 1 year prior to the abortion, and maintained insurance for at least 6 weeks post-abortion. Patients diagnosed with an ectopic pregnancy or a molar pregnancy were excluded.

A total of 1674 (3.33%) had an abortion-related event with 163 (0.32%) major events and 374 (0.74%) abortion-related infections. There were no significant differences in the primary outcome of abortion-related morbidity when the procedure occurred in an ASC versus an office-based setting (adjusted OR 0.97; CI₉₅ 0.81 to 1.17). There were no significant differences in the secondary outcomes of major abortion-related events (0.78; CI₉₅ 0.45 to 1.37) or in abortion-related infections (0.75; CI₉₅ 0.52 to 1.09) between procedure location. For first-trimester, medication-induced abortions, abortion-related adverse events were significantly more common in ASCs as compared to office-based settings (10.88% vs 5.36%; p= 0.003). There were no differences found in location among first-trimester aspiration abortions (0.84; CI₉₅ 0.66 to 1.07) and second-trimester or later abortions (1.01; CI₉₅ 0.75 to 1.37). There were no reported deaths during the study period.

Image: PD

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