Evidence map›Paper›PMID 31085561›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2019

Physician procedure volume and related adverse events after surgically induced abortion: a population-based cohort study.

Ning Liu, Simone N Vigod, M Michèle Farrugia, Marcelo L Urquia, Joel G Ray

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
2.4field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 14 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Abortion services in Canada: access and safety.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2019
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

Ning LiuInstitute 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.
Simone N VigodInstitute 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.
M Michèle FarrugiaInstitute 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.
Marcelo L UrquiaInstitute 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.
Joel G RayInstitute 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. rayj@smh.ca.
3M (United States) · USSinai Hospital · USUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

Abortion, InducedAdultAmbulatory Care FacilitiesClinical CompetenceFemaleHumansNeeds AssessmentOntarioPhysiciansPractice Patterns, Physicians'PregnancyQuality ImprovementRetrospective StudiesWorkloadYoung Adult

Identifiers

PMID31085561
PMCPMC6520066
OpenAlexW2944263555

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.