Introduction:  The aim of this prospective study was to examine the utilisation and cost effectiveness of the outpatient hysteroscopy clinic at Middlemore Hospital, South Auckland, NZ. The outpatient hysteroscopy service was set up 2 years ago, to rapidly assess women in the outpatient setting, without the need for general anaesthetic and its attendant risks, with the added advantage of reduction in costs from a reduction in theatre use.

Methods: Prospective demographic data, history, assessment and final histology, was entered onto a Microsoft Excel spreadsheet, for all women attending the clinic over a 12 month period for the year 2013.

Results:

There were 302 women referred to the outpatient hysteroscopy clinic.

Following hysteroscopy 158 were discharged or waitlisted for definitive surgery including hysterectomy.

124 were booked for a subsequent inpatient hysteroscopy, of whom 61 had polyps (49%), 26 cervical stenosis or difficulty tolerating outpatient hysteroscopy (21%), 14 due to clinical concern re malignancy or need for more extensive sampling (12%), 9 a sub mucous fibroid (7%), 6 declined outpatient (5%), 4 were not attempted (3%) and 4 had an unsatisfactory view or technical issues (3%).

A further 14 were referred to alternative clinics.

Most patients (89%) had an USS prior to hysteroscopy clinic, however we found USS was a poor predictor of polyps, with a PPV of 0.44, NPV of 0.95, sensitivity of 0.08, and specificity of 0.95.

For women who had an unsuccessful outpatient hysteroscopy due to cervical stenosis or discomfort the majority 43/45 (93%) were postmenopausal. Of postmenopausal women with an unsuccessful hysteroscopy, nulliparity was more common (16% versus 8%) this was not statistically significant (CI -0.02 – 0.22)

An inpatient hysteroscopy is costed as $2765.90. It is more difficult to quantify cost of an outpatient hysteroscopy but we estimate this to be $350.

To encourage the latter approach, we believe future strategies include introduction of versapoint bipolar electrosurgery system to enable polyp removal as an outpatient. In this study, introduction of this technology would have potentially saved $2415.90 per patient, which would have amounted to savings of $147,369.90 over 2013.