Women have almost twice the risk of severe complications in surgically induced abortion, which is otherwise a low-risk procedure, if their physician performs the procedure infrequently, claimed researchers.

The research was published in 'CMAJ' (Canadian Medical Association Journal). "A physician who performs more procedures, regularly, most likely gains proficiency, as well as the ability to recognise and troubleshoot potential problems. Experience and practice lower the likelihood of major complications," said the researchers Ning Liu and Dr Joel Ray.

Low physician procedure volume is known to be associated with an increased risk of complications after complex surgery for cardiac, cancer and pelvic conditions, but little was known about its association with a common and technically simpler procedure like surgical abortion. The study looked at data over 13 years, on 5,29141 induced surgical abortions performed before 20 weeks' gestation, and compared low-volume and high-volume physicians.

Severe adverse events occurred in 194 out of 52 889 procedures (3.7 per 1000 procedures) in the low-volume group and in 656 out of 476 252 procedures (1.4 per 1000 procedures) in the higher-volume group. Adverse events included injury to the mother, organ damage, admission to an intensive care unit and, very rarely, death within 42 days of the procedure.

"As serious adverse events are uncommon, any focus on centralising procedures must consider geographical access to surgically induced abortion and wait times, so that women who need the procedure can have it within a reasonable time frame," said Ning Liu. In a related commentary, Dr Wendy Norman and Dr Laura Schummers, University of British Columbia, Vancouver, wrote "An induced abortion with the nearest provider may be the safest option for a woman with an abnormal or unintended pregnancy, and may entail lower complication rates than delaying an abortion or carrying a pregnancy to birth." They noted that carrying a pregnancy to birth carries eight times higher risk than that the accompanying article found for abortion care.