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Day case hysteroscopy in NHS Lanarkshire: Opportunistically challenging conventions

Ellen Barton1, Miriam Stephens2
1NHS Greater Glasgow and Clyde, City of Glasgow, United Kingdom. 2University Hospital Wishaw, NHS Lanarkshire, North Lanarkshire, United Kingdom


Introduction: Day case hysteroscopies are carried out in NHS Lanarkshire but only one site has inpatient (IP) beds. 2018 policy was to book a bed for patients with a body mass index (BMI) over 38, many being seen at clinic to discuss spinal anaesthesia. Following interventions, the pandemic and reduced IP capacity, the BMI limit changed to over 40. We audited IP bed use, anaesthetic type and attitudes in 2022.

Methods: Following the 2018 audit, patients received information about spinal anaesthesia to manage expectations and reduce in-person pre-assessment.
We used Centricity™ Opera and Clinical Portal to identify hysteroscopy patients and gather information. We surveyed consultant attitudes to IP bed booking and anaesthetic approach.

Results: In 2018, 22 of 141 (15.6%) patients were admitted post-operatively. There was a low threshold to booking a bed in high BMI patients.
In 2022, 7 of 233 (3%) patients were admitted post-operatively. 63.2% of anaesthetists only required a bed with a BMI over 50. Concerning anaesthesia, 214 (91.8%) were general, 9 (3.9%) spinal and 10 (4.7%) local, with a higher (30%) spinal rate where BMI was >50. No patients with BMI >45, were screened for obstructive sleep apnoea (OSA).

Conclusions: Attitudes to IP bed requirement in high BMI patients have changed and admission rates are decreasing. The majority of cases in 2022 were under GA but without OSA screening. We recommend increasing the use of day case spinals in higher BMI patients along with OSA screening to assist decision-making.