Office Versus Hospital Based Essure Procedure: Pareto Principle in Action
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Objective: The primary purpose of this study was to compare physician time management/efficiency with Essure performance in office (using local anesthesia) versus ambulatory surgical center operating room (ASC OR) (using intravenous [i.v.] sedation). The secondary purpose was to compare patient satisfaction scores and adverse events. Methods: Per patient preference, patients seeking hysteroscopic sterilization were allocated to either location. Treatment time was defined as time patient entered the procedure room/OR until the time of facility discharge. Procedure time was defined as scope inscope out. All were performed by same attending physician. Satisfaction was graded as either not satisfied, satisfied or very satisfied. Adverse events were defined as uterine perforation, nausea/vomiting, unilateral placement, or vasovagal episode. Results: There were 20 patients per location. Procedure time was not statistically different (p=0.89, McNemar test); treatment time in office was significantly different (p=0.01, McNemar test). Mean treatment time in office was 17 minutes (range 1218) versus 126 (range 90180) for the ASC. Mean room turnaround time in office was 12 minutes (range 1016); 45 minutes in the ASC (range 3862) (p=0.002, McNemar test). More patients were very satisfied in office (18/20, 20%) than in the ASC (15/20, 75%). None reported being not satisfied. No significant adverse events were noted per site although 14/20 (70%) reported nausea/vomiting after i.v. sedation compared to none (0%) in office (p=0.001, unpaired t-test). Overall, 5 in-office Essures were completed within 3 hours, versus 3 in the ASC within 5 hours. Conclusions: Essure hysteroscopic sterilization performed in office (using local anesthesia) allows for improved physician time management/productivity compared to performing the procedure in an ambulatory OR. Office-based Essure may have substantial cost savings to the health care system based on time spent, with maximum patient satisfaction. (J GYNECOL SURG 28:16). 2012, Mary Ann Liebert, Inc. All rights reserved.
