• Ning Liu, Simone N Vigod, M Michèle Farrugia, Marcelo L Urquia, and Joel G Ray.
• Institute of Health Policy Management and Evaluation (Liu, Vigod, Ray), University of Toronto; ICES (Liu, Vigod, Urquia, Ray); Women's College Hospital and Department of Psychiatry (Vigod), University of Toronto; Mount Sinai Hospital (Farrugia); Department of Obstetrics and Gynaecology (Farrugia), University of Toronto; Dalla Lana School of Public Health (Urquia), University of Toronto; Departments of Medicine, and Obstetrics and Gynecology (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
• CMAJ. 2019 May 13; 191 (19): E519-E528.

BackgroundInduced abortion is a common procedure performed by physicians with varying degrees of clinical experience. We aimed to determine whether a physician's procedure volume influences complications after induced abortion.MethodsWe obtained population-based retrospective data on surgically induced abortion procedures in Ontario between 2003 and 2015 from Ontario health administrative databases held at ICES. Physician procedure volume was defined as the number of surgically induced abortions performed in the 1-year period preceding the index procedure date, categorized as low (< 10th percentile of yearly volume) or higher (≥ 10th percentile). The primary outcome was a severe adverse event (maternal end organ damage, severe maternal morbidity, intensive care unit admission or death) within 42 days after an induced abortion. The secondary outcome was any adverse event within 42 days.ResultsAmong 529 141 surgical abortion procedures, we found 850 severe adverse events (1.6 per 1000 procedures, 95% confidence interval [CI] 1.5-1.7), and 5664 any adverse events (10.7 per 1000 procedures, 95% CI 10.4-11.0). Severe adverse events occurred in 194 out of 52 889 procedures in the low-volume group (3.7 per 1000 procedures, 95% CI 3.2-4.2) compared with 656 out of 476 252 procedures in the higher-volume group (1.4 per 1000 procedures, 95% CI 1.3-1.5), an adjusted odds ratio (OR) of 1.91 (95% CI 1.41-2.59). The odds of any adverse event were also higher in the low-volume versus higher-volume group (adjusted OR 1.19, 95% CI 1.02-1.40).InterpretationLow physician procedure volumes are associated with an elevated risk of a complication after surgically induced abortion. Future investigation should compare processes of care between low- and higher-volume physicians to facilitate quality improvement in abortion care.© 2019 Joule Inc. or its licensors.

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