{
    "abstract": "Limited evidence exists on the influence of hospital procedure volume, socioeconomic status, and comorbidities on surgical abortion outcomes.\nOur study aimed to assess the association between hospital procedure volume, individual and neighborhood deprivation, comorbidities, and abortion-related adverse events.\nA nationwide population-based cohort study of all women hospitalized for surgical abortion was conducted from January 1, 2018 to December 31, 2019 in France. Annual hospital procedure volume was categorized into 4 levels based on spline function visualization: very low (<80), low ([80-300]), high ([300-650]), and very high-volume (\u2265650) centers. The primary outcome was the occurrence of at least one surgical-related adverse event, including hemorrhage, retained products of conception, genital tract and pelvic infection, transfusion, fistulas and neighboring lesions, local hematoma, failure of abortion, and admission to an intensive care unit or death. These events were monitored during the index stay and during a subsequent hospitalization up to 90\u00a0days. The secondary outcome encompassed general adverse events not directly linked to surgery.\nOf the 112,842 hospital stays, 4951 (4.39%) had surgical-related adverse events and 256 (0.23%) had general adverse events. The multivariate analysis showed a volume-outcome relationship, with lower rates of surgical-related adverse events in very high-volume (2.25%, aOR=0.34, 95% CI [0.29-0.39], P<.001), high-volume (4.24%, aOR=0.61, 95% CI [0.55-0.69], P<.001), and low-volume (4.69%, aOR=0.81, 95% CI [0.75-0.88], P<.001) wh en compared to very low-volume centers (6.65%). Individual socioeconomic status (aOR=1.69, 95% CI [1.47-1.94], P<.001), neighborhood deprivation (aOR=1.31, 95% CI [1.22-1.39], P<.001), and comorbidities (aOR=1.79, 95% CI [1.35-2.38], P<.001) were associated with surgical-related adverse events. Conversely, the multivariate analysis of general adverse events did not reveal any volume-outcome relationship.\nThe presence of a volume-outcome relationship underscores the need for enhanced safety standards in low-volume centers to ensure equity in women's safety during surgical abortions. However, our findings also highlight the complexity of this safety concern which involves multiple other factors including socioeconomic status and comorbidities that policymakers must consider.",
    "authors": [
        {
            "affiliation": "CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France; Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique-H\u00f4pitaux de Marseille, Marseille, France.",
            "firstname": "Aubert",
            "initials": "A",
            "lastname": "Agostini"
        },
        {
            "affiliation": "CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France; Department of Public Health, Assistance Publique-H\u00f4pitaux de Marseille, Marseille, France.",
            "firstname": "Vanessa",
            "initials": "V",
            "lastname": "Pauly"
        },
        {
            "affiliation": "Department of Public Health, Assistance Publique-H\u00f4pitaux de Marseille, Marseille, France.",
            "firstname": "Veronica",
            "initials": "V",
            "lastname": "Orl\u00e9ans"
        },
        {
            "affiliation": "CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France.",
            "firstname": "Yann",
            "initials": "Y",
            "lastname": "Brousse"
        },
        {
            "affiliation": "Department of Public Health, Assistance Publique-H\u00f4pitaux de Marseille, Marseille, France.",
            "firstname": "Fanny",
            "initials": "F",
            "lastname": "Romain"
        },
        {
            "affiliation": "CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France; Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.",
            "firstname": "Bach",
            "initials": "B",
            "lastname": "Tran"
        },
        {
            "affiliation": "CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France; Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.",
            "firstname": "Tham Thi",
            "initials": "TT",
            "lastname": "Nguyen"
        },
        {
            "affiliation": "Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.",
            "firstname": "Lee",
            "initials": "L",
            "lastname": "Smith"
        },
        {
            "affiliation": "Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.",
            "firstname": "Dong Keon",
            "initials": "DK",
            "lastname": "Yon"
        },
        {
            "affiliation": "CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France.",
            "firstname": "Pascal",
            "initials": "P",
            "lastname": "Auquier"
        },
        {
            "affiliation": "CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France; Department of Public Health, Assistance Publique-H\u00f4pitaux de Marseille, Marseille, France.",
            "firstname": "Guillaume",
            "initials": "G",
            "lastname": "Fond"
        },
        {
            "affiliation": "CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France; Department of Public Health, Assistance Publique-H\u00f4pitaux de Marseille, Marseille, France. Electronic address: laurent.boyer@ap-hm.fr.",
            "firstname": "Laurent",
            "initials": "L",
            "lastname": "Boyer"
        }
    ],
    "conclusions": "The presence of a volume-outcome relationship underscores the need for enhanced safety standards in low-volume centers to ensure equity in women's safety during surgical abortions. However, our findings also highlight the complexity of this safety concern which involves multiple other factors including socioeconomic status and comorbidities that policymakers must consider.",
    "copyrights": "Copyright \u00a9 2024 Elsevier Inc. All rights reserved.",
    "doi": "10.1016/j.ajog.2024.07.002",
    "journal": "American journal of obstetrics and gynecology",
    "keywords": [
        "abortion",
        "health services research",
        "public health",
        "social deprivation",
        "surgery"
    ],
    "methods": null,
    "publication_date": "2024-07-06",
    "pubmed_id": "38969198",
    "results": "Of the 112,842 hospital stays, 4951 (4.39%) had surgical-related adverse events and 256 (0.23%) had general adverse events. The multivariate analysis showed a volume-outcome relationship, with lower rates of surgical-related adverse events in very high-volume (2.25%, aOR=0.34, 95% CI [0.29-0.39], P<.001), high-volume (4.24%, aOR=0.61, 95% CI [0.55-0.69], P<.001), and low-volume (4.69%, aOR=0.81, 95% CI [0.75-0.88], P<.001) wh en compared to very low-volume centers (6.65%). Individual socioeconomic status (aOR=1.69, 95% CI [1.47-1.94], P<.001), neighborhood deprivation (aOR=1.31, 95% CI [1.22-1.39], P<.001), and comorbidities (aOR=1.79, 95% CI [1.35-2.38], P<.001) were associated with surgical-related adverse events. Conversely, the multivariate analysis of general adverse events did not reveal any volume-outcome relationship.",
    "title": "Association between hospital procedure volume, socioeconomic status, comorbidities, and adverse events related to surgical abortion: a nationwide population-based cohort study.",
    "xml": "<Element 'PubmedArticle' at 0x788505a7c770>"
}