Improving Access to Surgical Care Through a High-Volume, Operating Room-Based Hysteroscopy Program: A Transitional Model Towards Outpatient Delivery.

OBJECTIVES

Outpatient hysteroscopy offers a potential solution to improve access to gynaecologic surgical care; however, its widespread adoption remains limited in Canada. This quality improvement study aims to assess safety and efficiency outcomes of a dedicated high-volume operating room (OR)-based transitional hysteroscopy program.

METHODS

A retrospective observational study of patients who underwent elective hysteroscopy at a single tertiary care centre in Toronto, Canada, between April 3, 2023 and May 9, 2024 was performed. The preimplementation group (n = 251) comprised patients who underwent hysteroscopy in the 6 months prior to the introduction of a monthly high-volume OR-based hysteroscopy program. The post-implementation group (n = 70) included those who underwent surgery in the 8 months following the program's introduction.

RESULTS

Compared to the preimplementation group, the post-implementation group demonstrated significant reductions in median total OR time (52 [42-65] vs. 36 [31-39.75] minutes, P < 0.01), procedure length (19 [14-29] vs. 14 [10.25-18.75] minutes, P < 0.01), and recovery time (136 [112.5-172.5] vs. 114 [99.25-137.75] minutes, P < 0.01). Surgical wait times did not differ significantly between groups (95 [50-182.5] vs. 92 [54.25-124.75] days, P = 0.30). There was no statistically significant difference in complication rates.

CONCLUSIONS

Implementation of a high-volume, OR-based hysteroscopy program improved procedural efficiency without increasing complication or readmission rates. This model represents a feasible transitional approach for institutions aiming to expand toward a fully outpatient hysteroscopy service while maintaining patient safety and optimizing existing OR resources.