Moving Hysteroscopy from the Office to the Operating Room: A comparison of clinical outcomes and resource utilization

From the 2018 HVPAA National Conference

Jessica Shields (University of Texas Southwestern Medical Center, Dallas, TX;), Elizabeth Dilday (Parkland Health and Hospital System), Stephanie Chang (University of Texas Southwestern Medical Center, Dallas, TX;), Kimberly A. Kho (UTSW, Parkland Center for Healthcare Innovation and Clinical Outcomes Studies)

Background

Evaluation of the uterine cavity and endometrial lining is necessary during the workup of various gynecologic problems. Hysteroscopy has become the gold standard in the United States for evaluation and is one of the most common procedures performed by gynecologists.

Objectives

To compare utilization of resources and cost between hysteroscopies performed in the office and operating room (OR).

Methods

Retrospective chart review in a county-based safetynet teaching hospital Patients undergoing outpatient hysteroscopy from April 1, 2016 to March 31, 2017 were identified using an administrative database and medical records were reviewed, including demographic, procedural indications, preoperative evaluation and studies, number of clinical visits, total length of stay in the clinical environment and setting of their procedure (operating room or outpatient clinic).  A total of 305 patients met criteria for inclusion.

Results

Three hundred and five outpatient hysteroscopies were performed, 75 (24.6%) office and 230 (75.4%) OR. Demographic data and indications were similar between locations. The median number of pre-procedural clinic visits for office hysteroscopy was 1 (SD±0.37) compared to 2 (SD±0.74) for patients being treated in the OR (p-value <0.01).  Prior to hysteroscopy, patients undergoing office procedure required 1 (SD ±1.18) study costing an average of $17.56 (SD ±26.25) compared to OR procedures requiring 3.22 (SD ±6.11) studies costing an average of $45.66 (SD ±$51.59) (p-value <0.01).  Time spent at facility on the day of the procedure for patients undergoing office hysteroscopy was 153 minutes (SD ±58 minutes) compared to 337 minutes (SD ±168 minutes) for OR procedures.  Complications occurred in 1.3% of OR cases and 0% of offices cases.

Conclusion

When comparing hysteroscopies in office vs the OR, demographics and indications were similar. In office procedures required significantly less time for patients and fewer utilization of resources.  When considering costs broadly, at our institution, performing hysteroscopies in the OR costs 83% more than it does to complete the same procedure in the office.

Implications for the Patient

Office hysteroscopy is a high value, necessary, cost-reducing procedure for our patients.

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