Reducing Fluid-Related Complications During Operative Hysteroscopy: Use of a New Mandatory Fluid-Balance Form.

STUDY

OBJECTIVE

To examine whether our new reporting system and mandatory fluid-balance form could improve the communication and awareness within the surgical team and therefore the safety of hysteroscopic operations.

DESIGN

A case-control study (Canadian Task Force classification II-2).

SETTING

An endoscopic gynecology unit at a tertiary-care university hospital.

PATIENTS: Women aged 17 to 88 years (median, 43.9) who underwent operative hysteroscopy to treat uterine pathology.

INTERVENTIONS: Operative hysteroscopy was performed using bipolar technology and normal saline as an irrigation media with the new fluid-balance form and a mandatory reporting system. The control group was composed of women who underwent the procedure using the same technology, with a previous protocol.

MEASUREMENTS AND MAIN

RESULTS

Data regarding intraoperative and postoperative short-term complications were prospectively collected during surgery and at the 2-week follow-up visit. About 2000 procedures were investigated (601 in the study group and 1396 in the control group). In the control group there were 20 incidents of fluid deficit over 2 L. In 4 of these cases the procedure was terminated, but in the other 16 cases the procedure was continued, with or without awareness of the surgeons to the deficit. Of these cases, 2 suffered from media-related complications, and in 3 others complications were avoided by diuretics. In contrast, in the study group there were 10 incidents of fluid deficit over 2 L, of which 5 cases were terminated on time and the other 5 continued under the informed decision of the surgeon. In this group, none of the women experienced a media-related complication. The difference between the number of procedures that were terminated on time between the control and study groups was not statistically significant (p = .115). There was a statistically significant reduction in the total complication rate between the study group (1.8%) and the control group (3.9%; p = .019).

CONCLUSIONS

The fluid-balance form and mandatory reporting system have been shown to reduce the rate of total complications in hysteroscopic surgeries, in particular media-related complications. This result is achieved by an improvement of the awareness and communication among the operating team, leading to an improvement in procedure safety.