Original Article

Update on Trends for Inpatient Surgical Management of Tubal Ectopic Pregnancy in Maryland

Authors: Catherine A. Sewell, MD, MPH, Jean R. Anderson, MD

Abstract

Objectives: In Maryland, an analysis from 1994-1999 found that most hospitalized patients with tubal pregnancy underwent extirpative operations. The objective of this study was to determine whether practice patterns had changed over time.


Methods: Using the Maryland Health Service Cost Review Commission (HSCRC) database from January 1, 2000-December 31, 2004, subjects were identified by ICD-9 code 633.1, tubal pregnancy. The incidence of hospitalization was estimated based on state census data. Cases were analyzed by demographics, presentation, surgeon volume for ectopics, surgical treatment, length of stay, and charges.


Results: There were 2292 cases of tubal pregnancy identified, yielding an incidence for hospitalization of 4.81 per 10,000 women. The mean age of subjects was 29.6. Most were admitted through the emergency department (76.8%). Extirpative procedures were used in 88.01%. ER admission and increasing age were associated with extirpative surgery. Mean length of stay was 1.86 days; mean total charges were $5480.11.


Conclusions: A greater percentage of hospitalized ectopics were treated radically than prior. This may be due to acuity of presentation or regional surgical practices and preferences. Continued surveillance and a move toward improvement of Maryland's outcomes for ectopic pregnancy is needed. We propose an algorithm for emergency triage and management of pregnancy in an unknown location toward this end.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Mishell DR. Ectopic pregnancy: etiology, pathology, diagnosis, management, fertility prognosis. In: Mishell DR, Stenchever MA, Droegemueller W, et al, eds. Comprehensive Gynecology. 3rd ed. St Louis, MO: Mosby; 1997:431-465.
 
2. Centers for Disease Control and Prevention. Current trends in ectopic pregnancy-United States, 1990-1992. MMWR Morb Mortal Wkly Rep 1993;42:73-85.
 
3. Sewell CA, Cundiff GW. Trends for inpatient treatment of tubal pregnancy in Maryland. Am J Obstet Gynecol 2002;186:404-408.
     
6. Baumann R, Magos A, Turnbull A. Prospective comparison of videopelviscopy with laparotomy for ectopic pregnancy. Br J Obstet Gynaecol 1991;98:765-771.
 
7. Vermesh M, Silva PD, Rosen GF, et al. Management of unruptured ectopic gestation by linear salpingostomy: a prospective randomized clinical trial of laparoscopy versus laparotomy. Obstet Gynecol 1989;73:400-404.
 
8. Murphy AA, Nager CW, Wujek JJ, et al. Operative laparoscopy versus laparotomy for the management of ectopic pregnancy: prospective trial. Fertil Steril 1992;57:1180-1185.
 
9. Maymon R, Shulman A, Halperin R, et al. Ectopic pregnancy and laparoscopy: a review of 1197 patients treated by salpingectomy or salpingotomy. Eur M Obstet Gynecol Reprod Biol 1995;62:61-67.
 
10. Bangsgaard N, Lund CO, Ottesen B, et al. Improved fertility following conservative surgical treatment of ectopic pregnancy. Br J Obstet Gynaecol 2003;110:765-770.
 
11. Mohamed H, Maiti S, Phillips G. Laparoscopic management of ectopic pregnancy: a 5 year experience. J Obstet Gynaecol 2002;22:411-414.
 
12. Subak LL, Caughey AB. Measuring cost-effectiveness of surgical procedures. Clin Obstet Gynecol 2000;43:51-60.
 
13. Mertz HL, Yalcinkaya TM. Early diagnosis of ectopic pregnancy. Does use of a strict algorithm decrease the incidence of tubal rupture? J Reprod Med 2001;46:29-33.
 
14. Wuerz RC, Milne LW, Eitel DR, et al. Reliability and validity of a new five-level triage instrument .Acad Emerg Med 2000;7:236-242.
 
15. Manchester Triage Group. In: Mackway-Jones K, ed. Emergency Triage. London: BMJ Publishing Group; 1997.
 
16. Choi YF, Wong TW, Lau CC. Triage rapid initial assessment by doctor (TRIAD) improves waiting time and processing time of the emergency department. Emerg Med J 2006;23:262-265.
 
17. Christ M, Grossman F, Winter D, et al. Modern triage in the emergency department. Dtsch Arztebl Int 2010;107:892-898.
 
18. Bernhard M, Becker TK, Nowe T, et al. Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room. Resuscitation 2007;73:362-373.
 
19. O'Rourke D, Wood S. The early pregnancy assessment project: the effect of cooperative care in the emergency department for management of early pregnancy complications. Aust NZ J Obstet Gynaecol 2009:49:110-114.
 
20. Seeber BE, Sammel MD, Guo W, et al. Application of redefined human chorionic gonadotropin curves for the diagnosis of women at risk for ectopic pregnancy. Fertil Steril 2006;86:454-459.
 
21. Young PL, Saftlas AF, Atrash HK, et al. National trends in the management of tubal pregnancy, 1970-1987. Obstet Gynecol 1991;78(5 pt 1):749-752.
 
22. Zane SB, Kieke BA Jr, Kendrick JS, et al. Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States. Matern Child Health J 2002;6:227-236.
 
23. Van Den Eeden SK, Shan J, Bruce C, et al. Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstet Gynecol 2005;105:1052-1057.
   
25. O'Brien JA Jr, Jacobs LM, Pierce D. Clinical practice guidelines and the cost of care. A growing alliance. Int J Technol Assess Health Care 2000;16:1077-1091.
 
26. Calton WC, Franklin DP, Elmore JR, et al. Carotid endarterectomy: the financial impact of practice changes. J Vasc Surg 2000;32:643-648.
 
27. Warren JL, Yabroff KR, Meekins A, et al. Evaluation of trends in the cost of initial cancer treatment .J Natl Cancer Inst 2008;100:888-897.