Comparative Acuity of Emergency Department Visits Following Pregnancy Outcomes Among Medicaid Eligible Women, 2004-2015

Additional authors: Christopher Craver, M.A.

Abstract

Objectives: We sought to compare the acuity of emergency department (ED) visits following various pregnancy outcomes.

Methods: Cohorts of ED visits by continuously eligible Medicaid women between 2004-2015 were determined by the type of pregnancy outcome and a control group as follows: within 30 days of a chemical (mifepristone) abortion, surgical abortion, or live birth; and at any time for women who were never pregnant. The primary outcome was the percent of ED visits coded as either severe or critical (CPT codes 99284-99285). The study population was extracted from the 17 states where Medicaid pays for abortion services.

Results: All cohorts exhibited a pattern of both increasing incidence and acuity of ED visits. For the entire observation period, an ED visit following a chemical abortion was significantly more likely to have a severe or critical acuity rating than a visit following surgical abortion, live birth, or an ED visit at any time by a woman who was never pregnant. With never-pregnant women as a reference cohort, odds ratios (ORs) are as follows: chemical abortion 2.01 [1.93-2.28]; surgical abortion 1.53 [1.43-1.63]; live birth 1.01 [1.00-1.01]. With chemical abortion as the reference cohort, odds ratios (ORs) are: never-pregnant 0.48 [0.44-0.54]; live birth 0.52 [0.49-0.55]; surgical abortion 0.73 [0.68-0.77].

Conclusion: Consistent with national trends for ED visits, both the number and acuity of ED visits following pregnancy outcomes are increasing. ED visit acuity following chemical abortion is persistently and significantly higher than for surgical abortion or live birth.