Predictors of Successful Outpatient Hysteroscopy: A Retrospective Cohort Study

BACKGROUND: Outpatient hysteroscopy is increasingly being adopted in Australia as a technique to investigate abnormal uterine bleeding. Appropriate patient selection and pre-procedure counselling are essential for optimisation of patient experience. AIMS: To identify predictors of success at outpatient hysteroscopy. MATERIALS AND METHODS: This is a retrospective cohort study using a prospectively collected hospital-wide audit of all patients attending for awake diagnostic hysteroscopy in the outpatient hysteroscopy service at a tertiary hospital in Melbourne. Possible predictive factors were assessed for their relationship to the procedure outcome, adjusting for the proceduralist. The primary outcome was the probability of procedure completion ('completion'), defined as successful access to the endometrial cavity in the outpatient setting. The secondary outcome was the probability of procedure success ('success'), a composite of access to the cavity, with no reported complications, and the patient reporting a willingness to repeat the procedure as an outpatient again in the future. RESULTS: During the study period, a total of 2 392 outpatient hysteroscopy procedures were attempted. Completion was achieved in 93.4% of cases, and success was seen in 80.6% of cases. Both completion and success were associated with younger age, premenopausal status, and a history of vaginal birth. Previous cervical or tubal surgery, previous Caesarean section birth, and anticipated pain scores were not associated with either outcome. CONCLUSIONS: While hysteroscopic completion and success are high in all groups, premenopausal women with a history of a vaginal birth have the best outcomes and should be encouraged to consider an outpatient procedure where possible.