Abstract
Since the introduction of smaller instruments, hysteroscopy is increasingly performed in an office-based setting. The aim of this cohort study was to compare operative hysteroscopy in an office-based setting with inpatient procedures to evaluate differences in procedure and analgesia-related parameters. All office-based hysteroscopic procedures during February 2014 to October 2015 were entered for analysis. Included were morcellation of fibroids, polyps and pregnancy remnants, synechiolysis, diagnostic hysteroscopy, and endometrial ablation. Comparative cases of patients undergoing hysteroscopic surgery in the operating room were searched during the years prior to initiation of the office-based setting (2012 and 2013). During the outpatient surgical procedures, patients were moderate to deeply sedated with propofol and alfentanyl. Two groups of 129 patients were analysed. Median operation time was significantly shorter in the office-based group (11 min [range 1–37]) compared to the operating room group (20 min [range 2–73], p < 0.01). Median admission time was also shorter in the office-based group (135 min [range 60–150] versus 455 min [range 240–2865] (p < 0.01)). The number of incomplete procedures was similar (3.9 % versus 2.3 %, p = 0.473). No significant difference in surgical or anaesthesiology complications was observed. Overall complication rate was 4.7 % in the office-based setting and 3.9 % in the operating room setting. Financial analysis showed that procedures in an office-based setting are at least half of the costs as compared to a clinical setting. Office-based hysteroscopic procedures under procedural sedation and analgesia demonstrate a low complication rate as well as shorter operation and admission time compared to outpatient procedures. Office-based hysteroscopic procedures showed lower healthcare costs.
Similar content being viewed by others
References
Emanuel MH (2013) New developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol 27(3):421–429
Di Spiezio SA, Bettocchi S, Spinelli M, Huida M, Nappi L, Angioni S, Sosa Fernandez LM, Nappi C (2010) Review of new office-based hysteroscopic procedures 2003–2009. J Minim Invasive Gynecol 17(4):436–448
Favilli A, Mazzon I, Gerli S (2015) Pain in office hysteroscopy: it is not just a matter of size. Comment on: Paulo AA, Solheiro MH, Paulo CO. Is pain better tolerated with mini-hysteroscopy than with conventional device? A systematic review and meta-analysis: hysteroscopy scope size and pain. Arch Gynecol Obstet 292:987–994
Cicinelli E (2010) Hysteroscopy without anesthesia: review of recent literature. J Minim Invasive Gynecol 17(6):703–708
Lindheim SR, Kavic S, Shulman SV, Sauer MV (2000) Operative hysteroscopy in the office setting. J Am Assoc Gynecol Laparosc 7:65–69
Marsh F, Kremer C, Duffy S (2004) Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy. BJOG 111:243–248
Dutch Institute for Healthcare Improvement CBO (2009) Guideline PSA at locations outside the operation room
American Society of Anesthesiologists (2014) Continuum of Depth of Sedation: Definition of general anesthesia and levels of sedation/analgesia
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
Majholm B, Bartholdy J, Clausen HV, Virkus RA, Engbaek J, Moller AM (2012) Comparison between local anaesthesia with remifentanil and total intravenous anaesthesia for operative hysteroscopic procedures in day surgery. Br J Anaesth 108:245–253
Centini G, Calonaci A, Lazzeri L, Tosti C, Palomba C, Puzzutiello R, Luisi S, Petraglia F, Zupi E (2015) Parenterally administered moderate sedation and paracervical block versus general anesthesia for hysteroscopic polypectomy: a pilot study comparing postoperative outcomes. J Minim Invasive Gynecol 22:193–198
Wortman M, Dagget A, Ball C (2013) Operative hysteroscopy in an office-based surgical setting: review of patient safety and satisfaction in 414 cases. J Minim Invasive Gynecol 20:56–63
Nilsson A, Nilsson L, Ustaal E, Sjoberg F (2012) Alfentanil and patient-controlled propofol sedation facilitate gynaecological outpatient surgery with increased risk of respiratory events. Acta Anaesthesiol Scand 56:1123–1129
Cooper NA, Clark TJ, Middleton L, Diwakar L, Smith P, Denny E, Roberts T, Stobert L, Jowett S, Daniels J (2015) OPT Trial Collaborative Group. Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study. BMJ: 350
Rubino RJ, Lukes AS (2015) Twelve-month outcomes for patients undergoing hysteroscopic morcellation of uterine polyps and myomas in an office or ambulatory surgical center. J Minim Invasive Gynecol 22:285–290
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Author van Vliet received fees on hourly basis for lectures and training on hysteroscopic morcellation by Smith and Nephew. The fees were donated to a foundation which promotes research in obstetrics and gynaecology. Author Smits, Author Kuijsters, Author Braam, and Author Schoot declare that they have no conflict of interest.
Ethical approval
Our study was exempt for Institutional Review Board (IRB) approval as the use of existing data was provided without the identification of living individuals. Our research did not involve animals.
Rights and permissions
About this article
Cite this article
Smits, R.M., Kuijsters, N.P., Braam, L. et al. Therapeutic hysteroscopy in an outpatient office-based setting compared to conventional inpatient treatment: superior? a cohort study. Gynecol Surg 13, 339–344 (2016). https://doi.org/10.1007/s10397-016-0974-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10397-016-0974-0