Study Population
This study was approved by the Research Ethics Committee at the Tel Aviv Sourasky Medical Center (0749-15-TLV on 10.11.2016). We used the data on all consecutive women 70 years of age or older who were referred to our medical center for a hysteroscopy procedure between March 2011 and August 2018. Patients in the office hysteroscopy group were retrieved from the hysteroscopy clinic’s medical charts, and patients in the OR hysteroscopy group were identified according to their OR diagnosis (ICD codes 68.12 and 68.16). All hysteroscopic interventions that had been performed during the study period were reviewed, including repeat hysteroscopies for the same patient. Cases of repeat hysteroscopic procedures for the same patient that were not related to her primary procedure were excluded from the analysis. All the patients referred to either office or OR hysteroscopy had undergone at least one gynecological examination that included an ultrasound study before their referral to our unit.
Women were assigned to the postmenopausal bleeding (PMB) group if they presented with PMB, regardless of ultrasonographic findings. Women who were referred due to any ultrasound finding with no PMB were assigned to the abnormal sonographic findings group.
The “see-and-treat” technique was implemented in our institution with the opening of a new outpatient hysteroscopy clinic in 2011, and a change of clinical practice of referring women to the office instead of directly to the OR as a first-line procedure was gradually introduced in our medical community.