1
in an operating room compared with MVA in office setting. This finding was statistically significant.
2
The evidence for this outcome was of moderate and very low quality.
3
One study found a higher proportion of women receiving a blood transfusion following EVA in an
4
operating room compared with MVA in an office setting. This finding was statistically significant. The
5
evidence for this outcome was of low quality.
6
One study found higher mean blood loss in women following EVA in an operating room compared
7
with MVA in an office setting. This finding was statistically significant. The evidence for this outcome
8
was of very low quality.
9
One study did not find a statistically significant difference in the proportion of women that presented to
10
an emergency department on the same day of treatment following EVA in an operating room
11
compared with MVA in an office setting. The evidence for this outcome was of low quality.
12
One study did not find a statistically significant difference in the proportion of women that reported
13
passing tissue within 48 hours of treatment following EVA in an operating room compared with MVA
14
in an office setting. The evidence for this outcome was of very low quality.
15
One study did not find a statistically significant difference in success rate 30 days after treatment in
16
women following EVA in an operating room compared with MVA in an office setting. The evidence for
17
this outcome was of very low quality.
18
One study did not find a statistically significant difference in the proportion of women that developed
19
fever after treatment following EVA in an operating room compared with MVA in an office setting. The
20
evidence for this outcome was of very low quality.
21
One study did not find a statistically significant difference in maximum total satisfaction score in
22
women following EVA in an operating room compared with MVA in an office setting. The evidence for
23
this outcome was of very low quality.
24
One study did not find a statistically significant difference in post procedure infection in women
25
following EVA in an operating room compared with MVA in an office setting. The evidence for this
26
outcome was of very low quality.
27
One study did not find a statistically significant difference of need for re-evacuation in women
28
following EVA in an operating room compared with MVA in an office setting. The evidence for this
29
outcome was of very low quality.
30
Evidence to recommendations
31
Relative value placed on the outcomes considered
32
The GDG considered the success rate of the treatment to be the most important outcome for this
33
question. In addition, the group felt that need for an emergency hospital visit was also an important
34
measure as an indicator of the comparative safety of the procedure in the different settings.
35
Consideration of clinical benefits and harms
36
The evidence showed that the only differences between care in the different settings were the median
37
waiting time, the number of women requiring a blood transfusion, and the mean blood loss (all of
38
which favoured an outpatient setting). The group noted that the rate of blood transfusions, in the study
39
which reported this outcome, was particularly high in both arms and that this evidence was unlikely to
40
be applicable to a UK setting. In addition, the group noted that the study which reported the mean
41
blood loss outcome had more than twice as many women in one arm than the other and that this was
42
likely to have affected the results.
43
Consideration of health benefits and resource uses
44
It was recognised that there would be an initial cost for units to set up the facility for performing
45
manual vacuum aspiration as an outpatient procedure. However, once these costs have been met, it
46
is likely that an outpatient setting would be cost-effective, given the reduced time for conducting the
47
procedure.
48
Quality of evidence
1
The evidence was generally of very low quality and so the group did not feel able to make a strong
2
recommendation that all surgical management should routinely be conducted as an outpatient
3
procedure. However, the group did feel that the evidence about reduced waiting times justified a
4
recommendation that units should be able to offer surgical management as an outpatient procedure in
5
order to provide women with a choice.
6
Information giving and psychological support
7
The GDG felt that it was important that women were given appropriate information about the different
8
treatment options and what to expect during the procedure, in order that they could make an informed
9
choice about their treatment. In addition, they agreed that women should be provided with information
10
about what to expect during the recovery period.
11
Other considerations
12
The group recognised that some women will prefer to have the procedure conducted under general
13
rather than local anaesthetic (i.e. in a theatre setting). In addition, they recognised that at later
14
gestations, it may not always be clinically appropriate to offer the procedure without a general
15
anaesthetic. As a result, they did not feel it appropriate to recommend that all surgical procedures be
16
conducted as an outpatient procedure.
17
Recommendations
18
Number
Recommendation
67 Where clinically appropriate, offer women a choice of:
manual vacuum aspiration under local anaesthetic in an out-patient or clinic setting
evacuation in a theatre under general anaesthetic.
68 Provide written and verbal information to all women undergoing surgical management about the treatment options available and what to expect during and after the procedure.