A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding

Abstract

Uterine polyps can cause abnormal bleeding in women. Conventional practise is to remove them under general anaesthesia but advances in technology have made it possible to perform polypectomy in the office setting. We conducted a patient-preference study to explore women’s preferences for treatment setting and to evaluate the effectiveness and treatment experience of women undergoing uterine polypectomy. Three hundred ninety-nine women with abnormal uterine bleeding who were found to have uterine polyps at diagnostic hysteroscopy were recruited. Office polypectomies were performed in office hysteroscopy clinics, and inpatient procedures were undertaken in operating theatres. Three hundred twenty-four of 399 (81 %) expressed a preference for office treatment. There was no difference found between office treatment and inpatient treatment in terms of alleviating abnormal uterine bleeding as assessed by patients and in improving disease-specific quality of life. Acceptability was lower and patient pain scores were significantly higher in the office group. When offered a choice of treatment setting for uterine polypectomy, patients have a preference for office over inpatient treatment. Ambulatory gynaecology services should be available within healthcare systems to meet patient demand.

Pain relief in hysteroscopy

“…Pain can be exacerbated by the patient's anxiety and vary in different types of procedures. Although patient acceptability for outpatient operative hysteroscopy is high, the pain score for operative hysteroscopy is higher than for diagnostic hysteroscopy 14,15 . In a study of >500 women with outpatient hysteroscopy under local anaesthesia, those with operative hysteroscopy had higher mean maximum pain scores than those with diagnostic hysteroscopy 16 .…”