Is every patient eligible to have an office hysteroscopy? A retrospective analysis of 1301 procedures

Introduction
Hysteroscopy is the gold standard for diagnosis and treatment of uterine pathologies. The office setting seems to be safe, reducing the anesthesia risks and also decreasing the overall costs of the procedure. Recent literature suggests that hysteroscopy performed without anesthesia may not be as painless as it was previously considered. Moreover, not every patient can be referred for a hysteroscopy in an office setting.

Aim
To analyze the factors correlated with a successful hysteroscopy in an office setting.

Material and methods
We analyzed the documentation of 1301 patients who underwent hysteroscopy at our department in the period 2013–2016. The impact of the type of the procedure and the various demographic factors on the need for general anesthesia was assessed.

Results
Almost 80% of all hysteroscopies were performed without analgesia in an office setting. The remaining patients underwent a hysteroscopy in general anesthesia. The key aspect for successful office hysteroscopy is the scope of the performed surgery. Over 91% of diagnostic hysteroscopies have been done without analgesia, but only about 30% of extensive endometrial scratching procedures were performed in an office setting. A previous vaginal delivery increases the chances for a successful office hysteroscopy by about 21%, and in the case of diagnostic procedures, multiparous patients were at an about 79% lower risk of analgesia necessity.

Conclusions
It is possible to perform nearly all diagnostic hysteroscopies in an office setting. In the case of operative hysteroscopy, the most crucial factor is the scope of the procedure.