A Scottish audit of hysteroscopic surgery for menorrhagia: complications and follow up

Abstract

Objective To evaluate the efficacy and safety of hysteroscopic surgery undertaken by a cross section of gynaecologists. Design A prospective registration of cases of hysteroscopic surgery by gynaecologists. Patient satisfaction was assessed at six and twelve months post-operatively by postal questionnaire. Setting Thirteen hospitals in seven Scottish Health Boards. Secretariat in Aberdeen Royal Infirmary. Subjects Women having hysteroscopic surgery for menstrual problems. Interventions A few questions were added to the proforma during the audit. Results Between December 1991 and December 1993, 978 cases were registered. Consultants performed the majority of procedures. Complications occurred in 12% of cases and included one death from toxic shock syndrome. Uterine perforation and significant fluid overload occurred in 1 % of cases. To date, 732 women have been followed up at six months, 554 at twelve months and 80 at 24 months. Eighty-four percent of those returning their questionnaires were satisfied or very satisfied at twelve months. By twelve months, repeat procedures had been performed in 13% and hysterectomy in 11%. Sixty-six percent of women with a paid job had returned to work within two weeks and 88% within four weeks. Conclusions Overall, hysteroscopic surgery had a low rate of morbidity and satisfactory efficacy with rapid post-operative recovery. Gynaecologists who have shown caution with the advent of this surgery can now be encouraged to take up endometrial ablation for dysfunctional uterine bleeding. Clinical guidelines are currently being prepared.