Design: A retrospective observational analysis comparing mean number of hysteroscopies performed per month in the OR before and after introduction of operative hysteroscopy in clinic. We compared the 12 months before the intervention to 12 months after the intervention, not including a 4-month washout period immediately after the intervention. Results were analyzed using an unpaired t-test.

Setting: A tertiary care safety net hospital.

Patients or Participants: All patients who underwent hysteroscopy in the OR from September 2021 to December 2023, excluding a washout period from September 2022 to December 2022.

Interventions: Tissue morcellator hysteroscopes and fluid management systems were obtained in our hospital-affiliated gynecology clinic in September 2022. Prior to this, we only had capabilities to perform diagnostic hysteroscopies in clinic and patients who required resection of a lesion were referred to the OR. Revisions were made to clinic templates and analgesia techniques to accommodate the clinic setting. Patients with suspected intrauterine pathology underwent clinic hysteroscopy with a tissue morcellator device which allowed for see-and-treat procedures rather than additional referral to OR.

Measurements and Main Results: 125 hysteroscopies were performed in the OR in the 12 months pre-intervention compared to 45 cases in the 12 months post-intervention. The mean OR hysteroscopies per month statistically significantly decreased by 64.6% from 10.58 pre-intervention to 3.75 post-intervention (p=0.0001). Using a cost analysis by Keyhan (2014), we estimate our health system saved approximately $273,000 in 2023 with this intervention. Additionally, patients were able to avoid repeat hysteroscopies, additional pre-op appointments (gynecology clinic, pre-anesthesia assessments, EKG, chest radiography, and lab draws), as well as the risks of general anesthesia.

Conclusion: Implementation of clinic operative hysteroscopy statistically decreased OR utilization for hysteroscopy allowing time for other procedures. It also decreased patient appointment time commitment and was cost saving for our health system.