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Obstetrics & Gynecology 2006;108:103-110
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Patient Preferences, Satisfaction, and Resource Use in Office Evacuation of Early Pregnancy Failure

Vanessa K. Dalton, MD, MPH1, Lisa Harris, MD2, Carol S. Weisman, PhD3, Ken Guire, MS4, Laura Castleman, MD, MPH5 and Dan Lebovic, MD6

From the 1 Department of Obstetrics and Gynecology, Womens' Hospital, University of Michigan Medical Center; 2 University of Michigan Medical Center; 3 Division of Health Services Research, Penn State College of Medicine, State College, Pennsylvania; 4 Department of Biostatistics, University of Michigan; 5 University of Michigan; and 6 Division of Reproductive Endocrinology, University of Michigan Medical Center, Ann Arbor, Michigan.

OBJECTIVE: To examine patient treatment preferences and satisfaction with an office-based procedure for early pregnancy failure and to compare resource use and cost between office and operating room management of early pregnancy failure.

METHODS: This study was a prospective observational study of 165 women presenting for surgical management of early pregnancy failure. Participants completed a preoperative questionnaire addressing treatment preferences and expectations and a postoperative questionnaire measuring level of pain experienced and satisfaction with care. Resource use was determined by measuring the time patients spent at the health care facility and the actual procedure time. Cost was estimated using an institutional database.

RESULTS: One hundred fifteen women from the office and 50 from the operating room were enrolled. Patients selecting outpatient management scored "privacy," "avoiding going to sleep," and "previous experience" higher than the operating room group (P < .05). Patients who perceived that their physicians preferred one procedure over the other were more likely to select that procedure (P < .001). Satisfaction was high in both groups, and underestimating the procedure's discomfort was negatively associated with satisfaction (P < .002). Costs were greater than two-fold higher in the operating room group compared with the office group (P < .01). Complications were uncommon, but hemorrhage-related complications were four times more common in the operating room group than in the office group (P < .01).

CONCLUSION: Office-based surgical management of early pregnancy failure is an acceptable option for many women and offers substantial resource and cost savings.

LEVEL OF EVIDENCE: II-2






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Copyright © 2006 by the American College of Obstetricians and Gynecologists.