Update on trends for inpatient surgical management of tubal ectopic pregnancy in Maryland

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.