title: Is outpatient hysteroscopy the new gold standard? Results from an 11 year prospective observational study.
abstract: BACKGROUND
  In Australia, gynaecologists continue to investigate women with abnormal bleeding and suspected intrauterine pathology with inpatient hysteroscopy despite some evidence in the literature that that there is no difference in safety and outcome when compared to an outpatient procedure.
  
  
  OBJECTIVE
  This prospective study assessed the safety, effectiveness and acceptability of outpatient hysteroscopy over 11 years at a tertiary hospital in Australia. Resource savings were then calculated.
  
  
  METHODS
  A prospective database was analysed from March 2003 to January 2014 (130 months, 990 women).
  
  
  RESULTS
  Successful hysteroscopic access was obtained in 94% of cases. Twenty-six percent of patients required a second procedure, including 132 for endometrial polyps and 33 for submucosal fibroids that were not able to be treated in the outpatient setting. On questioning, 88% of women would be happy to have the procedure again. Factors affecting success were pre-procedure pain, menopausal status and previous vaginal delivery. The difference between pain experienced versus pain expected was a major factor in patient acceptability. A vasovagal episode occurred in 5% of cases.
  
  
  CONCLUSIONS
  Outpatient hysteroscopy was demonstrated to be safe, effective and acceptable to women. Provision of an outpatient hysteroscopy service saves theatre time and approximately $1000 per case. Improved techniques and technology will allow progression to a 'see and treat' service, providing further savings. With budget constraints, increasing wait times for major procedures and concerns about trainee surgical experience, an outpatient hysteroscopy service should be considered the 'gold standard' investigation over hysteroscopy in theatre.
authors.affiliation: Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Ma
authors.affiliation: Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Readman
authors.affiliation: Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hicks
authors.affiliation: Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Porter
authors.affiliation: Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Cameron
authors.affiliation: Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia.
authors.forename: Lenore
authors.initials: L
authors.lastname: Ellett
authors.affiliation: Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Mcilwaine
authors.affiliation: Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia.
authors.forename: Janine
authors.initials: J
authors.lastname: Manwaring
authors.affiliation: Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Maher
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000592:standards*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000592:standards*; D007434:Intrauterine Devices; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010298:Parity; D010342:Patient Acceptance of Health Care; D011127:Polyps / Q000601:surgery; D011446:Prospective Studies; D019233:Retreatment; D019462:Syncope, Vasovagal / Q000209:etiology; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: acceptability; ambulatory; hysteroscopy; outpatient; pain