title: Treating incomplete abortion in El Salvador: cost savings with manual vacuum aspiration.
abstract: When manual vacuum aspiration (MVA) was introduced to treat incomplete abortion at a regional training hospital in El Salvador, this study evaluated the impact of replacing sharp curettage with MVA. Hospital cost, length of hospital stay, complication rates and postabortion contraceptive acceptance were compared in a prospective, nonrandomized, controlled study of 154 women assigned to either traditional sharp curettage services or MVA services plus contraceptive counseling. Assignment depended on availability of trained providers. Compared to sharp curettage, use of MVA and associated changes in protocol led to a significant cost savings of 13% and shorter hospital stay of 28%. Dedicated family-planning counseling resulted in a threefold higher rate of contraceptive acceptance. Although the difference in cost was significant, much higher savings could be realized if minimal postoperative stays were implemented for both procedures. Barriers to early discharge include patient expectations, physician attitudes and training and hospital systems administration.
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Jackson Park Road, Portland, OR 97201, USA. koontzs@ohsu.edu
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Koontz
authors.forename: Olga
authors.initials: O
authors.lastname: Molina de Perez
authors.forename: Kathleen
authors.initials: K
authors.lastname: Leon
authors.forename: Anne
authors.initials: A
authors.lastname: Foster-Rosales
mesh_terms: D000027:Abortion, Incomplete; D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D003475:Curettage / Q000009:adverse effects / Q000191:economics; D004544:El Salvador; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011247:Pregnancy; D011446:Prospective Studies; D014619:Vacuum Curettage / Q000009:adverse effects / Q000191:economics*