Therapeutic hysteroscopy in an outpatient office-based setting compared to conventional inpatient treatment: superior? a cohort study

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.