From the Journals

Abortion not safer at an ambulatory surgical center

View on the News

Reassurance on safety of office-based abortion

This new analysis provides further support that office settings are appropriate for abortion care and that office-based abortion care is appropriately safe, effective, and patient centered.

Results of this study support the safety of office-based abortions, including a low risk of infection, they added.

This comparison study of office-based abortion to abortion provided in an ambulatory surgery center (ASC) is important because 16 states impose restrictions that require abortion facilities adhere to ASC or ASC-equivalent standards.

Converting an office to an ASC is slow, complex, and although the cost of retrofitting a facility is moderately less, building an ASC costs an estimated $5 million, according to industry experts.

Requiring an office to meet an ASC-equivalent standard with no medical justification is too high a hurdle in many areas and serves to restrict women’s access to abortion.

Carolyn L. Westhoff, MD, and Anne R. Davis, MD, are with the department of obstetrics and gynecology at Columbia University, New York. These comments are based on their editorial in JAMA (2018 Jun 26;319[24]:2481-2483). Dr. Westhoff is the editor of Contraception and a senior medical advisor at Planned Parenthood Federation of America. Dr. Davis is consulting medical director for Physicians for Reproductive Health, a consultant for the New York City Department of Health, and an expert for the American Civil Liberties Union.



Abortion performed in an ambulatory surgery center (ASC) was not associated with a significant difference in abortion-related complications, compared with procedures performed in an office-based setting, according to results of a retrospective cohort study.

Low rates of abortion-related morbidities and adverse events were observed in both ASCs and office-based settings in the study, which was based on data for 49,287 women with U.S. private health insurance who had induced abortions between 2011 and 2014.

These findings might help inform decisions about the type of facility where induced abortions are performed, according to Sarah C. M. Roberts, DrPH, of the University of California, San Francisco, and her coauthors.

The U.S. Supreme Court ruled in 2016 that a Texas law requiring abortion facilities to meet ASC standards was unconstitutional, Dr. Roberts and her coauthors wrote in JAMA.

“Despite this ruling, 13 states currently have laws that require abortions to be provided in ASCs,” the authors wrote, noting that supporters of the laws argue that these requirements make abortions safer.

The laws have requirements such as separate procedure and recovery rooms, and specified hall and door widths. “Many of these apply only at a specific gestational week or gestational duration, typically in the second trimester,” they noted, adding that over 95% of induced abortions are performed in outpatient settings such as clinics or physician offices.

Their retrospective cohort study included a total of 50,311 induced abortions, of which 89% took place in office based settings and 11% in ASCs. Nearly half (47%) were first-trimester aspiration procedures, while 27% were first-trimester medication and 26% were second trimester or later.

Abortion-related morbidity or adverse events were reported for 3.33% of procedures overall. The adjusted incidence rate was 3.25% for ASC-based procedures, and similarly, 3.33% for office-based procedures.

The overall complication rate was higher than previous estimates based on insurance claims data, they said, but the estimate of major events was similar at 0.32%, breaking down to 0.26% for ASCs and 0.33% for office-based settings. The rate of infections was 0.58% for ASCs and 0.77% for office-based settings.

This is not the first study looking at the association between abortion-related events and the procedure setting, though the literature is limited, according to Dr. Roberts and her coauthors. One previous study showed fewer abortion-related events in clinics than in hospitals, while a recent review found similar abortion-related events following first-trimester abortions in hospitals, ASCs, and office-based settings.

One limitation of the current study is that the database included only abortions that were paid for by private insurance, which represents about 15% of the nearly 1 million procedures done each year in the United States.

“Thus, findings may not be generalizable to all abortions in the United States,” Dr. Roberts and her coauthors wrote.

The study was supported by a grant from the Society of Family Planning Research Fund. Study authors reported no conflicts of interest.

SOURCE: Roberts SCM et al. JAMA. 2018 Jun 26;319(24):2497-2506.

Next Article: