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.