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Supporters of laws demanding that abortions be performed in outpatient surgery centers (ASC) claim that facilities make the procedure safer, but a new study has shown that abortions performed in offices and other ASCs do not not the patients.
Based on a sample of 49,287 women having suffered 50,311 abortions, the rate of adverse events or morbidity related to abortion between CHWs (3.25%) and the practices (3 , 33%) was not statistically significant in an adjusted analysis, reported Sarah Roberts, MD, of the University of California at San Francisco, and colleagues in the Journal of the American Medical Association.
"Thirteen states have laws that require abortions to be provided in CHWs, many [which] only apply in the second quarter, "Roberts said MedPage today. "These laws are generally enacted for the stated purpose of making the abortion safer. Our study indicates that these laws are not evidence-based and that they are useless for improving patient safety." ;abortion."
The Roberts group controlled for the quarter in which the abortion occurred, the age, the number of outpatient health care consultations the previous year, the region and the number of patients. year. During the first quarter, there were 13,480 medically induced abortions and 23,891 induced abortions. In the second quarter or later, there were 12,940 abortions. Most (89%) were conducted in office environments.
Of the events related to abortion, 2.52% of first trimester events followed abortions by aspiration and 5.42% came from medical abortions. Those taking place in CHWs are more frequent than those taking place in offices in the South (25.1% vs. 12.6%, P<0.001) and the Midwest (22.6% vs. 11.5%, P<0.001).
Developing an ASC takes time and money, and most of them maintain strict regulation. Although the cost of converting existing offices to CSA is considerably lower, it is estimated that it will cost $ 5 million to build a new facility, leaving women with limited options during the construction of the centers.
In the 13 states that require abortions to be performed in CHWs, additional requirements related to airflow, sinks and sterile operating rooms and corridors are generally included for procedures that enter into the CHWs. the skin. However, as abortion procedures are performed through non-sterile openings of the vagina and cervix, these requirements are not necessary, said Carolyn Westhoff, MD, of Columbia University Medical Center in New York, in an editorial which accompanied the study. The results "provide important data to support the safety of office-based abortion care, including a low risk of infection in procedural settings for the population of women included in the study", she wrote.
The study data comes from Truven, a database of health insurance claims, which provided a sample of private insured women from 50 states, who had abortions between 2011 and 2014. The researchers used the PAIRS framework to classify abortions. abortion-related events in diagnoses, including products withheld from conception, failed abortion, hemorrhage, infection and cervical lesions, among others. Major events were those requiring night hospitalization, additional surgery or blood transfusion.
In all, abortion-related events, major events, and infections occurred in 3.33%, 0.32%, and 0.74% of patients, respectively. Unadjusted analyzes found no significant difference with major events between AUC (0.25%) and office settings (0.33%), or with infections (0.58% vs. 0.76%). %, respectively).
Since the study received data on insurance claims, it does not include abortions not covered by private insurance, which account for 85% of the approximately 1 million 39, abortions that occur each year. In addition, 17,000 women treated at hospital sites (including hospital, outpatient and emergency services) were excluded from the study.
Potential confounding factors such as body mass index, breed and previous caesarean section have not been controlled. Finally, the database does not provide the number of weeks where abortion occurred in the sampled women, which could affect the results if there were inconsistencies between the time of abortion in both places.
The study aligns with previous reports that found fewer abortion-related events in clinics than hospitals and that little or no difference could be found between the rates of the clinics and the hospitals. Events occurring after abortions in offices, hospitals and CHWs. Almost all (95%) of induced abortions occur in abortion clinics, non-specialized clinics or doctors' offices.
"Previous research has shown that ASC laws are associated with a decrease in the availability of abortion services, which makes abortion more difficult for women," Roberts said. "When women are unable to get an abortion and instead continue pregnancy, they are more likely to have physical health problems, are more likely to be attached to violent men and more likely to be financially insecure.
The study was funded by a grant from the Research Fund of the Family Planning Society, an organization that studies family planning, contraception and abortion. The organization played no role in the design of the study.
Roberts and his coauthors have not reported any conflict of interest.
Westhoff is the editor of Contraception, serves as a medical advisor to Planned Parenthood, and was previously affiliated with the Society for Family Planning.
Davis is affiliated with Physicians for Reproductive Health (a nonprofit organization that supports access to abortion), and has been an expert for the American Civil Liberties Union in the challenges to restrictions. Abortion based on the state.
1969-12-31T19: 00: 00-0500
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