Audit of endometrial biopsy at outpatient hysteroscopy

Outpatient hysteroscopy (OPH) and endometrial biopsy (EMB) are less invasive alternatives to inpatient hysteroscopy and dilatation and curettage for assessment of the endometrium. Using local anaesthetic, the procedure is readily tolerated and can be completed in an ambulatory setting. This study aims to audit OPH and EMB conducted over three consecutive years with regard to the ability to complete the procedure and subsequent pathology.

Data were retrospectively collected from the medical records of patients who underwent OPH during the study period. Data collected included demography, medical history, procedure details and outcome. An indicative assessment of the resource requirements for provision of these services in an outpatient versus inpatient setting was also conducted based on published cost information.

Between June 2003 to June 2006, 435 OPH were performed and 427 of these were available for audit. Four hundred and five (94.8%) of the procedures were successful. Sixty-five (18.8%) EMBs were reported to be insufficient, of which 41 (63%) were in postmenopausal women (P < 0.001). Women who presented with postmenopausal bleeding were significantly more likely to have an insufficient sample (P < 0.001). The Australian Refined Diagnosis Related Groups cost for inpatient hysteroscopy is $A1,786, including $A711 in theatre costs and $A258 in ward costs. These costs are not incurred with OPH.

This study indicates that hysteroscopy and EMB can be easily and successfully performed as an outpatient procedure in Australia. Pathology can be readily identified and management planned. Moreover, an opportunity exists for a reduction in resource use by utilising this procedure instead of inpatient hysteroscopy where possible.