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

Roberts, Sarah C. M., DrPH*†; Beam, Nancy, PhD, RN, MPH, MSN*†; Liu, Guodong, PhD; Upadhyay, Ushma D., PhD, MPH*†; Leslie, Douglas L., PhD; Ba, Djibril, MPH; Kerns, Jennifer L., MD, MPH

doi: 10.1097/PTS.0000000000000553
Original Article: PDF Only

Objective The aim of the study was to examine whether miscarriage treatment–related morbidities and adverse events vary across facility types.

Methods A retrospective cohort study compared miscarriage treatment–related morbidities and adverse events across hospitals, ambulatory surgery centers (ASCs), and office-based settings. Data on women who had miscarriage treatment between 2011 and 2014 and were continuously enrolled in their insurance plan for at least 1 year before and at least 6 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 6 weeks of miscarriage treatment. Secondary outcomes were major events and infections.

Results A total of 97,374 miscarriage treatments met inclusion criteria. Most (75%) were provided in hospitals, 10% ASCs, and 15% office-based settings. A total of 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 between ASCs and office-based settings was no longer significant for miscarriages treated with procedures.

Conclusions Although there seem to be slightly more events in hospitals than ASCs or office-based settings, findings do not support limiting miscarriage treatment to particular settings.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

From the *Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health;

Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California; and

Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.

Correspondence: Sarah C. M. Roberts, DrPH, ANSIRH, University of California, San Francisco 1330 Broadway, Suite 1100 Oakland, CA 94612 (e-mail: sarah.roberts@ucsf.edu).

This study was supported by the Society of Family Planning Research Fund (SFPRF10-10) and a grant from an anonymous private foundation. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

The authors report no conflict of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.journalpatientsafety.com).

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