Office versus Operating Room Hysteroscopy: A Comparison of Outcomes and Resource Utilization [3R

Abstract

INTRODUCTION: Parkland Hospital Gynecology Clinic initiated office hysteroscopy while continuing hysteroscopy in the operating room (OR). This study compares utilization of resources between office and OR cases. METHODS: Retrospective chart review of hysteroscopies from April 1, 2016 to March 31, 2017 in the OR, Ambulatory Surgery Center (ASC) and Gynecology Clinic. Data regarding preoperative evaluation, operative details and time spent the day of the procedure was collected. RESULTS:- Patients undergoing procedures in the office and OR were similar with median age 44 SD ±11.0 vs 46 SD ±11.1 years (p=0.92) and BMI of 30.7 SD ±7.6 vs BMI of 34.4 SD ±9.0 kg/m2 (p=0.82). -75 (24.6%) office and 230 (75.4%) OR hysteroscopies were performed -Indications for office procedures were: 33 (44%) suspected polyp, 23 (30.7%) IUD related, 7 (9.3%) postmenopausal bleeding, and 6 (8%) intracavitary mass. Indications for OR were: 65 (28.4%) suspected polyp, 36 (15.7%) hyperplasia, 29 (12.7%) abnormal uterine bleeding and 24 (10.5%) IUD related -34.6% of office procedures required OR hysteroscopy for: 9 (40.9%) large polyp, 5 (22.7%) pain, 9 (22.7%) cervical stenosis, and 3 (13.6%) fibroid found. There were 3 (1.11%) complications in the OR and 0 (0%) in the office (p=0.32). Patients undergoing office procedures spent 153 minutes (SD ±57 minutes) in clinic compared to 337 minutes (SD ±168 minutes) for OR (p=0.02). Prior to hysteroscopy, patients undergoing office hysteroscopy required 1.01±1.17 studies vs 3.12±6.12 studies (p=0.003). CONCLUSION: When comparing hysteroscopies in the office versus the OR, demographics and indications were similar. In-office cases involved significantly less time from patients and superior utilization of resources.