Outpatient Surgery Research Articles

Assessment of the Patient's Perceived Fear and Anxiety During Ambulatory Holmium Laser Enucleation of Prostate: A Prospective, Real-Practice Study from a Single Center.

Background and Objective: Ambulatory holmium laser enucleation of prostate (HoLEP) has shown low rates of readmission and postoperative complications. However, the patient's experience has been undervalued. We aimed to measure the patient's perceived fear and anxiety during ambulatory HoLEP. Methods: We performed a prospective study on patients scheduled for HoLEP at our institution. We excluded patients with cognitive or psychiatric disorders and those who had to be hospitalized. The week preceding the surgery, we administered the Surgical Fear Questionnaire (SFQ) and the Hospital Anxiety and Depression Scale (HADS) by phone. The day following the surgery, we readministered the HADS and asked the patients if they would undergo HoLEP in the same setting. Key Findings and Limitations: Overall, 70 patients completed the study (mean age 72.3, standard deviation [SD] 6.5 years). The mean SFQ score was 18.4/90 (SD 13.5); the two highest rated items were "I am afraid of pain after the operation" and "I am afraid of unpleasant side effects after the operation." with a mean of 3.7/10 and 2.7/10, respectively. For the HADS, the mean preoperative score was 4.6/21 (SD 3.4), and the mean postoperative score was 3.9/21 (SD 3.0), with a mean difference of -0.7 (p = 0.059). The majority (90%) of patients reported they would undergo HoLEP in the same setting. Conclusions and Clinical Implications: Most patients described low levels of anxiety and fear, and would undergo ambulatory HoLEP again. Given the high satisfaction and low levels of anxiety, widespread adoption of ambulatory HoLEP should be considered. Patient Summary: Men with benign prostatic hyperplasia, or an enlarged prostate, often need surgery to improve urinary function. We studied the acceptability of same-day discharge surgery for this condition by assessing patients' anxiety, fear, and willingness to repeat the procedure. Most patients described low levels of anxiety and fear, and would undergo ambulatory HoLEP again.

Revision Reverse Total Shoulder Arthroplasty as an Outpatient Procedure.

Revision Reverse Total Shoulder Arthroplasty as an Outpatient Procedure.

Outpatient surgery in trauma surgery and orthopedics

Outpatient surgery is gaining in importance, not least due to the politically driven structural transformation in the German healthcare system. As aresult, more and more trauma surgery and orthopedic procedures as well as corresponding inpatient services are being carried out on an outpatient basis. Assuming a correct selection of suitable patients and acomprehensive outpatient care structure, outpatient surgery is not only less expensive but is also associated with increased patient satisfaction and safety. While other countries already have established outpatient care systems in place, these still need to be developed and expanded in Germany. The outpatient trend in hospital medicine aims to relieve hospitals, create resources and counteract the rising costs in the healthcare system. This requires afinancially sustainable, cost-effective and patient-centered approach that does not harm either the patient or the healthcare provider.

Optimization and impact of an evidence-based pre-audit prescription decision system in primary healthcare settings

ObjectiveAnalyze the operation mode of the prescription pre-audit intelligent decision system in a county-level hospital, evaluate its intervention effects on outpatient and emergency operations, thus providing references for similar hospitals to carry out pre-audit intelligent decision system and promote rational drug use.MethodsUtilizing evidence-based approaches, system rule modifications have been refined and synergized with AI-driven decision-making analytics to examine the operational framework of pre-audit prescription decision system. Additionally, retrospectively analyze the types and levels of problems triggered by outpatient and emergency prescriptions from October 2022 to August 2023, as well as the rationality of prescriptions in the system.ResultsAccording to the clinical operation of the hospital, problems triggered by unreasonable prescriptions have been finely classified into different levels according to the severity of prescription problems. From October 2022 to August 2023, the number of prescriptions triggering issues such as indications, dosage, special populations, compatibility, administration, and contraindications showed a decreasing trend compared with October 2022 before the intervention. For example, the number of prescriptions with unreasonable routes of administration decreased from 1,745 to 20, and the number of contraindicated prescriptions decreased from 1,399 to 16. The prescriptions triggering Level 5 alerts decreased from 5.609% to 1.793% and the prescription compliance rate increased from 92.20% to 95.98%.ConclusionThe prescription pre-audit intelligent decision system enhances patient safety and promotes rational drug use. However, the system requires fine-tuning and continuous improvement of the system rule library to effectively validate prescriptions and improve prescription accuracy. In the future, integrating big data, artificial intelligence and other technologies for secondary system development will be a model worthy of consideration. In addition, promoting this system to medical federation to establish a regional prescription review model will further promote the high-quality development of pharmaceutical services.

Cost and Efficiency of Drug-Induced Sleep Endoscopy: Endoscopy Suite Versus Outpatient Surgery Center.

Drug-induced sleep endoscopy (DISE) is used to identify airway obstruction patterns in patients with obstructive sleep apnea (OSA). This procedure is typically performed in either the traditional operating room (OR) or an outpatient surgery center (SC). There is limited data regarding the cost and efficiency of DISE in the endoscopy suite (ES). This study compares the cost, efficiency, and safety of DISE performed in the ES compared to the SC. This retrospective review included patients who underwent DISE between July 2023 and April 2024 at a single tertiary care center. Consecutive patients with CPAP-intolerant OSA undergoing DISE in the ES or SC were included. Patient demographics, sleep studies, procedure-related costs, procedure duration characteristics, and anesthesia documentation were analyzed. Eighty-four patients (36 ES, 48 SC) were included. Patient sex, age, BMI, and preoperative AHI/REI were similar in both cohorts (p > 0.05). DISE in the ES significantly reduced total facility time (48 min, p < 0.0001), time in procedure room (6.6 min, p < 0.0001), DISE procedure time (1.7 min, p = 0.0034), total recovery time (30.4 min, p < 0.0001), and procedure room turnover time (7.1 min, p = 0.0012). Costs for ES procedures were 39.35% lower, specifically in costs associated with anesthesia, operating room, and recovery room (all comparisons, p < 0.001). No complications occurred in either group. Performing DISE in the ES increases efficiency and reduces costs compared to the outpatient SC while maintaining safety for patients with CPAP-intolerant OSA.

Review of computed tomography imaging can decrease nontherapeutic transfer after facial trauma.

Maxillofacial trauma encompasses a spectrum of injuries, from minor facial fractures to severe craniofacial defects, some requiring urgent surgical intervention while others are managed nonoperatively. Remote evaluation of patients by facial trauma specialists before transfer could provide an opportunity to reduce the number of nontherapeutic transfers. Our institution's trauma registry was queried for adult patients transferred from a system hospital with facial injuries. A random selection of 150 patients with computed tomography (CT) imaging available for review from the transferring facility was selected. Facial trauma surgeons then reviewed charts and CT images to determine the need for surgery, the timing of surgery, and additional clinical information needed to make this determination. The mean age was 50 years, with a median Abbreviated Injury Scale score of 2. Based on CT imaging, 27% would require surgery, 57% did not require surgery, and 16% were indeterminate and required additional clinical information. Of those who were indeterminant, 80% required an eye examination, 24% required an oral examination, and 28% required a nasal examination. Of those requiring surgery, only 7% had urgent indications in less than 24 hours. Surgery during the same admission was appropriate for 68% of patients, and 25% of patients would have been suitable for outpatient surgery. Based on CT imaging alone, the reviewers proved to have 100% accuracy in determining whether the patient was nonoperative or in need of urgent surgery. This study demonstrates that most transfers for facial fractures are low grade and nonoperative. Remote CT evaluation of patients with facial fractures could significantly decrease the incidence of nontherapeutic transfers. Therapeutic/Care Management; Level IV.

Inpatient Revision Total Knee Arthroplasty Has a Higher Risk of Early Complications: A Propensity Score Matched Analysis With Outpatient Revision TKA.

Inpatient Revision Total Knee Arthroplasty Has a Higher Risk of Early Complications: A Propensity Score Matched Analysis With Outpatient Revision TKA.

Computer tomography-assisted 3-dimensional navigation in spine surgery: a narrative review on safety, accuracy, efficacy and reduction of complications

The computed tomography-assisted 3D navigation system is a useful tool for spinal surgeons, enabling them to enhance the effectiveness and safety of surgical procedures by providing real-time three-dimensional information during decompression, resection, and instrumentation. Specific advantages of this navigation system include precise pedicle screw placement, the capability for immediate intraoperative correction, and execution of minimally invasive surgeries with reduced radiation exposure for the surgical team. Noteworthy disadvantages of this system are the relatively high implementation costs, the need for specific training, and limited accessibility to outpatient surgery centers. Currently, spinal navigation systems are constantly being upgraded with additional innovations, such as integration with robotics and improvement of the existing tools, which will ultimately lead to a better quality of life for patients and an improved experience for surgeons.

Sitting vs. standing: The impact of surgeon posture on patient perception of visit duration in the outpatient plastic surgery clinic.

Sitting vs. standing: The impact of surgeon posture on patient perception of visit duration in the outpatient plastic surgery clinic.

Failure to Participate in Pre-operative Arthroplasty Education is Associated with Longer Length of Stay and Lower Rates of Same-day Discharge and Discharge Home

Introduction Hip and knee arthroplasty continues to evolve with better techniques, protocols, and outcomes. Patient education is critical to disabuse patients of outdated expectations about surgery and recovery. Formal preoperative education programs are widely used, but not all patients participate. This investigation seeks to evaluate length of stay and functional outcomes in patients who do not participate in a preoperative education class compared with those who do. Methods 376 consecutive patients over 6 months having primary hip and knee arthroplasty at an urban academic medical center were retrospectively reviewed. Patients who did not participate in education (n=17) were compared to those who did (n=359). The primary outcome was mean length of stay (LOS); secondary outcomes included improvement in knee motion, discharge to home rates, and same-day surgery rates. Results Patients who failed to participate had longer LOS (2.2 vs 1.2 days, p&lt;0.001) and lower rate of same-day surgery (0% vs 24.0%, p=0.045). Participants had a higher rate of home discharge (90.3% vs 52.9%; OR 8.23; 95% CI [2.98, 22.7]; p&lt;0.001). We found no significant differences in change of knee range of motion. Conclusion Patients not participating in preoperative education were associated with a longer hospital admissions and were more likely to fail planned discharge home after hip and knee arthroplasty. This study corroborates multiple prior studies showing the importance of preoperative education.

Using a Patient‐Reported Outcome (PRO) Questionnaire to Assess Postoperative Care Following Pediatric Outpatient Surgery

ABSTRACTIntroductionIn recent years, there has been a marked rise in the incidence of pediatric day surgery across Western countries. As postoperative recovery transitions to the home environment, it is incumbent on healthcare systems to develop methods for patient follow‐up and caregiver support.AimTo describe a method of monitoring the postoperative home treatment of children, as well as giving families appropriate support and guidance.MethodWe developed and implemented an electronic patient‐reported outcome (PRO) questionnaire, designed to assist parents in assessing and managing pediatric postoperative care at home following day surgery. We present questionnaire response rates, reasons for nonresponse, and the frequency and causes of postdischarge contact with the hospital.ResultsSince its implementation in 2020, our PRO questionnaire has captured postoperative home‐care data from 530 families. The questionnaire facilitated the identification of 157 families requiring additional postoperative support following discharge. The primary postoperative complication identified was pain, with nausea and vomiting being less frequently reported as isolated concerns.ConclusionWe have found the use of a postdischarge electronic questionnaire helpful in the postoperative care and provision of timely guidance to families.

Same-Day Discharge Ambulatory Surgery Centers: The Importance of Preoperative Workup for Aesthetic Surgery Patients

Abstract Background Limited resources combined with an increasingly ‘cost-conscious’ approach to healthcare has resulted in a reduction of preoperative investigations that have been deemed unnecessary. While this approach may work in the hospital setting where ancillary services and emergency support are readily available, it may actually be impacting patient safety in the ambulatory surgery center (ASC) setting. Objectives The purpose of this study was to determine the prevalence of abnormal results arising from routine preoperative workup amongst patients undergoing aesthetic surgery in the outpatient ASC setting. The goal was to examine whether abnormal results led to alterations in care that otherwise would not have been made had the workup not been performed, and to outline patient factors associated with alterations in care. Methods A retrospective chart review was performed of 2,596 consecutive patients who underwent aesthetic surgery over a 40-month period at a single Canadian ambulatory surgery center. Data collected included patient demographics, procedural characteristics, and outcomes. Preoperative workups were categorized as either required (for patients with positive findings on medical history and/or physical examination) or supplementary (for otherwise healthy patients). Results A total of 2,581 patients met inclusion criteria for the study. The majority of patients were female (91.2%) and underwent breast surgery (60.3%). All patients underwent independent preoperative medical history and physical examination with bloodwork/screening. In total, 838 patients (32.5%) had abnormal bloodwork results while 240 (9.3%) had abnormal ECGs. These abnormal tests resulted in alterations in care for 242 patients (9.4% of total patients with 293 unique care alterations). Alterations in care included pharmacotherapy (n=104, 35.5%), additional investigations (n=78, 26.6%), specialist consultations (n=67, 22.9%), and postponement of surgery (n=44, 15.0%). Demographic variables associated with alterations in care included: age ≥50 (p&amp;lt;0.00001), female sex (p=0.0235), higher ASA class (p&amp;lt;0.00001), and preexisting medical comorbidities (p&amp;lt;0.00001). Conclusions Preoperative workups are an important factor for improving patient safety in outpatient aesthetic surgery. These investigations can uncover occult issues that may increase the risk of complications in the ASC setting.

Are Canadian Outpatient Ambulatory Surgery Centres Safe? An Assessment of 2,596 Consecutive Aesthetic Surgery Patients

Abstract Background Ambulatory surgery centres (ASC) with same-day discharge criteria are the most common setting for aesthetic surgery in Canada. However, to date, no study has reviewed the safety of outpatient aesthetic surgery performed in the Canadian ASC setting. Objectives The purpose of this study was to evaluate the overall safety profile of aesthetic surgery in ASCs, to determine how often in-hospital resources were utilized following outpatient aesthetic surgery, and to examine how predictor variables impact adverse outcomes in this setting. Methods A retrospective chart review of 2,596 consecutive patients who underwent aesthetic surgery over a 40-month period at a single Canadian ASC was performed. Data extracted included demographics, operative details, and postoperative complications. Results A total of 2,581 patients met inclusion criteria. The majority of patients were female (91.2%) with a mean age of 37.6 years (range 18-85). Most patients had a BMI in the normal weight range (56.3%) and 70.0% were classified as ASA Class I score. Patients predominantly underwent breast/chest surgery (60.3%) with a procedure duration under 2 hours (59.2%). Mean PACU time was 109 minutes (range 72-420 min). In total, ten patients (0.4%) utilized hospital resources in the post-operative period, with three (0.1%) direct hospital transfers from the ambulatory surgery centre. No patients underwent reoperation in the hospital setting. Overall, 67 (2.4%) patients experienced complications that were managed within the ASC setting. Combined procedures (p=0.1367), lipoaspirate volume (p=0.53) and procedure duration (p=0.92) were not associated with an increased risk of adverse outcomes. Conclusions Aesthetic surgery in the ASC setting is safe, with a low associated complication rate. Utilization of hospital resources in the post-operative period is rare.

Cost of Neoadjuvant Immunotherapy vs Up-Front Surgery in Cutaneous Squamous Cell Carcinoma

There is increasing interest in use of neoadjuvant immunotherapy (NAT) in advanced cutaneous squamous cell carcinoma (cSCC) to reduce surgical morbidity and forego adjuvant therapy, while potentially improving survival outcomes. To assess the cost to Medicare of NAT compared with up-front surgery. This cohort study was a post hoc analysis of a phase 2 clinical trial evaluating the feasibility of neoadjuvant atezolizumab. The study was conducted from June 2021 to December 2023 at a tertiary-level academic institution among 20 patients with advanced stage II-IV cSCC. Up to 3 doses of neoadjuvant atezolizumab, followed by surgical resection with or without adjuvant radiation therapy. Direct medical costs in US dollars of care received on trial were compared with baseline treatment plans of up-front surgery developed a priori from a Medicare payer perspective. Of 20 patients with advanced cSCC enrolled (median [range] age, 71.5 [53-88] years; 17 male [85.0%]), most individuals had stage III (12 patients [60.0%]) or IV (5 patients [25.0%]) disease. The median (range) follow-up was 14.2 (3.5-28.7) months. Compared with $26 602.67 for up-front surgery, NAT was associated with mean overall costs of $51 561.02, or a 93.8% increase, equivalent to $24 958.36 (95% CI, $22 057.95 to $24 692.43) per patient, which was primarily associated with the drug acquisition costs of atezolizumab ($30 603.96). NAT was associated with mean cost reductions from $12 707.07 to $10 543.71 (17.0%) in surgery and $11 711.97 to $7157.32 (38.9%) in radiation across all patients compared with up-front surgery. Adjuvant radiation therapy was obviated in 5 of 17 patients not previously irradiated (29.4%), reducing costs of radiation. Mean (SD) surgical complexity was reduced from 63.81 (30.55) to 44.71 (32.49) work relative value units (wRVUs; difference, 19.10 wRVU; 95% CI, 5.00 to 33.20 wRVU). NAT was associated with 5 fewer free flaps, 4 fewer neck dissections, 5 more organ-preserving resections, and 3 conversions from inpatient to outpatient surgery. This study found that treatment with 3 doses of NAT was associated with an overall cost increase compared with up-front surgery, driven by drug acquisition costs, and cost reductions from less extensive surgical resections and obviated adjuvant radiation. Predictive markers for response to NAT could optimize patient selection and improve cost-effectiveness. ClinicalTrials.gov Identifier: NCT04710498.

Teens and opioids postsurgery (TOPS): protocol for a prospective observational study describing associations between sleep deficiency and opioid use following outpatient surgery in adolescents

IntroductionThe opioid crisis is a significant burden on adolescent public health in the USA. Medical use of prescription opioids is a pathway via which adolescents transition to opioid misuse, opioid...

Effects of a virtual reality digital twin of the operating theatre on anxiety in pediatric surgery patients: a randomized controlled trial.

Sevoflurane-based volatile induction and maintenance of anesthesia (VIMA) is common in pediatric outpatient surgery but can elevate preoperative anxiety in unfamiliar settings. This study compared the effects of immersive 3D virtual reality (VR) digital twin that precisely simulated the operating theatre environment with those of two-dimensional (2D) video education on preoperative anxiety in pediatric patients undergoing VIMA. In total, 102 pediatric patients undergoing elective ambulatory surgery were randomly assigned to either the VR or tablet group. Identical preoperative education was provided through a 3D VR digital twin or tablet video. Preoperative anxiety, induction compliance, and procedural behavior during anesthesia induction were assessed using the modified Yale Preoperative Anxiety Scale (mYPAS), induction compliance checklist (ICC), and procedural behavior rating scale (PBRS), respectively. The VIMA induction times, and parental satisfaction were recorded. Children in the VR group exhibited lower mYPAS (33.3 [23.3-49.2] versus 46.7 [33.3-55.8], P = 0.022), higher ICC (P = 0.007), and lower PBRS (0.0 [0.0-1.0] versus 1.0 [0.0-2.0], P = 0.009) scores than those in the tablet group. The VIMA induction time was also shorter in the VR group (305.0 [253.5-392.5] versus 382.0 [329.0-480.0] s, P = 0.002), although parental satisfaction was comparable between the two groups. Compared with video education, preoperative education utilizing an immersive 3D VR digital twin enhanced the efficacy of VIMA process, resulting in reduced preoperative anxiety, increased compliance, lower distress during anesthetic induction, and shorter induction time.

Characteristics and outcomes of older patients undergoing out- versus inpatient surgery in Europe. A secondary analysis of the Peri-interventional Outcome Study in the Elderly (POSE).

The number of older patients undergoing surgical procedures with anaesthesia care is projected to rise. In order to cope with the increased demand, the expansion of outpatient surgery may play a decisive role. We aim to investigate the characteristics and outcomes of the older outpatient population. The Peri-interventional Outcome Study in the Elderly in Europe (POSE) was a prospective multicenter study investigating characteristics and outcomes in 9497 patients aged 80 years and older undergoing a procedure with anaesthesia care. This secondary analysis of the POSE data investigated characteristics, functional and cognitive outcomes, and mortality in the outpatient in comparison to the inpatient population. Functional status was assessed as independent, partially dependent, and totally dependent at baseline and 30 days postinterventional. Cognitive status was defined by the number of recalled words (0-3) in the Mini-Cog test and brief cognitive screening at baseline and follow-up. Out of the 9497 older patients, 7562 were planned inpatients and 1935 planned outpatients. Older outpatients presented with fewer comorbidities and fewer medications than older inpatients and underwent minor procedures more often Their baseline functional status was more often independent, and they had a higher estimated probability of staying independent. Outpatients recalled three words at baseline and follow-up more often than inpatients. The estimated 30-day survival probabilities with 95% confidence intervals were 0.997 [0.994; 0.999] in the group with planned outpatient surgery and 0.948 [0.942; 0.953] with planned inpatient surgery. Our results indicate that functional and cognitive status at baseline and follow-up were higher in planned outpatients than in planned inpatients. However, only short screening tools for the assessment of functional and cognitive status were used. Overall, outpatient interventions were associated with low mortality. Further research is recommended to develop scores that facilitate the identification of patients suitable for outpatient surgery. This secondary analysis of a prospectively collected cohort of elderly surgical cases in Europe describes case factors related to inpatient compared to outpatient surgical interventions. The findings show that inpatient or outpatient surgery selection is associated with different degrees of risk for important perioperative outcomes in this cohort.

Outpatient gastrointestinal foreign body surgeries performed in a nonspecialized setting have good outcomes for dogs and cats

Abstract Objective To determine the survival rate and prognostic indicators for outpatient gastrointestinal foreign body (GIFB) surgeries performed on dogs and cats in a nonspecialized setting focused on the spectrum of care. Methods Electronic medical records were searched for dogs and cats undergoing GIFB surgery from July 13, 2022, to August 28, 2023. Variables of interest were compared across 3 groups: patients euthanized intraoperatively and those that survived ≥ 2 weeks postoperatively (survivors) or died &lt; 2 weeks postoperatively (nonsurvivors). For patients without a postoperative recheck, a phone survey was conducted. Results 102 dogs and 40 cats received GIFB surgery. The 2-week survival rate for dogs was 95% (80/84), not including 11 euthanized intraoperatively and 7 lost to follow-up. The 2-week survival rate for cats was 91% (29/32), not including 2 euthanized intraoperatively and 6 lost to follow-up. Higher preoperative albumin, creatinine, and BUN or intestinal perforations identified intraoperatively were associated with decreased survival in dogs. Perforations were associated with intraoperative euthanasia in cats, but other parameters did not differ significantly. Of 20 respondents surveyed regarding outpatient recovery, reported issues included anorexia (5/20) and diarrhea (2/20), none of which required additional care. Only 2/20 felt burdened by outpatient care, and all reported that they would have the outpatient procedure performed again if needed. Conclusions In a nonspecialized setting, the survival rate was high for outpatient GIFB surgeries and comparable to reported inpatient survival. Clinical Relevance General practices should consider offering these outpatient surgeries as part of the spectrum of care.

Trends in Abortion Rates in Ontario, Canada

Following decades-long declines, significant increases in abortion rates have been reported in some jurisdictions from 2020 to 2023, but it is not yet known whether these trends are occurring in Canada. To assess abortion rates in Ontario from 2012 to 2022 and to examine trend changes associated with mifepristone availability, the COVID-19 pandemic, and postpandemic periods. This population-based interrupted time series cohort study examined all medication and procedural abortions provided in Ontario from January 1, 2012, to December 31, 2022, to females aged 15 to 44 years with provincial insurance coverage, identified using linked health administrative data that included records from practitioner billings, inpatient and outpatient hospital services, same-day surgeries, and outpatient prescription dispensations. Availability of mifepristone regulated as a normal (ie, prescribed by an authorized prescriber without additional certification or registration and dispensed by a pharmacist) prescription medication (in November 2017) and the COVID-19 pandemic period (from March 2020 to December 2021). The main outcome was the abortion rate (number of abortions per 1000 females per year) overall and within age strata, using an interrupted time series design. Of 422 867 medication and procedural abortions identified using data from health records of 225 540 reproductive-aged females (mean [SD] age, 28.5 [6.6] years), the abortion rate declined steadily from 15.6 abortions per year per 1000 females, aged 15 to 44 years, in 2012 to 12.3 in 2021 and then increased to 14.1 in 2022. When mifepristone was introduced in 2017 as a normal prescription medication, no immediate change in the abortion rate (-0.1 [95% CI, -0.7 to 0.8]) and a nonsignificant slope increase (0.6 [95% CI, -0.5 to 0.7]) were found. However, this trend resulted in an additional 1.5 (95% CI, 0.3-2.6) abortions per 1000 females by the first quarter of 2020 compared with premifepristone trends; rates increased more among those aged 15 to 19 years, less among those aged 35 to 44 years, and did not increase for those aged 25 to 29 years. During the pandemic period, abortion rates decreased by 1.2 (95% CI, -2.5 to -0.8), most pronounced among those aged 20 to 34 years. Compared with expected rates based on premifepristone trends, 5-year availability of normally prescribed mifepristone was associated with a rate difference of 1.9 (95% CI, 0.7-5.4) in 2022, with a greater increase among those aged 20 to 24 years (4.2 [95% CI, 1.5-9.0]) and no change among those aged 25 to 29 years (1.0 [95% CI, -1.7 to 6.2]). The increased abortion rate in 2022 was consistent with 5-year trends following normally prescribed mifepristone, although social forces potentially impacting international rates may have contributed. This study found that, following longstanding declines, abortion rates in Ontario gradually increased with mifepristone availability in 2017 in Ontario. Following a pandemic-related decrease in rates (in 2020 and 2021), substantial increases in abortion rates reported elsewhere from 2020 to 2023 did not occur in Ontario as of 2022, suggesting that Ontario's health services environment and Canada's regulatory and policy approach to preserving reproductive health services may have helped stabilize abortion rates. Future research is needed to understand how sociocultural changes affecting abortion service use elsewhere may be affecting contraception access and use and thus abortion rates in Canada.

Success of outpatient hysterectomy: V-Notes versus Vaginal hysterectomy.

Success of outpatient hysterectomy: V-Notes versus Vaginal hysterectomy.