Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo-ovarian abscesses
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GENERAL GYNECOLOGY
Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo‑ovarian abscesses Tiffany Tuck Chin Wong1 · Hester Chang Qi Lau1 · Thiam Chye Tan1 Received: 30 October 2019 / Accepted: 6 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Management of tubo-ovarian abscesses (TOA) is often complex and may include antibiotics, image-guided drainage via interventional radiology (IR) or surgery. We aim to (i) identify clinical factors that prognosticate primary drainage and (ii) compare outcomes of each treatment regimen. Methods This is a retrospective analysis on patients with TOA, admitted to KK Hospital, a tertiary women’s hospital in Singapore from June 2016 to June 2017. Pregnant patients or patients who were discharged against medical advice were excluded. 102 patients were included in this study. Results 85.3% patients received antibiotics only, while 14.7% patients received antibiotics with IR drainage or surgery (primary drainage) as initial treatment. Subsequently, 20.7% failed antibiotic treatment and required IR drainage or surgery (secondary drainage). Patients aged above 40 years, TOA diameter of larger than 7 cm and presence of fever were found to be predictive of antibiotic failure, requiring secondary drainage. However, patients with primary drainage had a longer length of stay by 2.69 days (95% CI 1.44–3.94, p value < 0.001), compared to patients successfully managed conservatively. Conclusion Patients who are above 40 years, febrile and have a larger TOA are at a higher risk of medical treatment failure, and should, therefore, be recommended for primary drainage at presentation. Further prospective studies should be conducted with a larger sample size to compare the outcomes of conservative management versus drainage of TOA. Keywords Tubo-ovarian abscess · Image-guided drainage · Surgical drainage · Surgery · Conservative treatment · Antibiotics treatment
Introduction Tubo-ovarian abscess (TOA) is an inflammatory mass involving the fallopian tube, ovary, and occasionally other adjacent pelvic organs (e.g., bowel, bladder) [1]. TOAs are frequently a complication of pelvic inflammatory disease (PID), an upper genital tract infection. PID and TOA are often associated with long term sequelae such as chronic abdominal pain, infertility and ectopic pregnancies. Traditionally, treatment for TOA consisted of antibiotics and laparotomy, usually involving unilateral or bilateral salpingo-oopherectomy and/or hysterectomy. These were often curative, but were also associated with higher morbidity,
infertility and early menopause [1]. Today, management of TOA has changed with the advent of broad-spectrum antibiotics, image-guided drainage techniques by interventional radiology (IR) and laparoscopic techniques. The British Association for Sexual Health and HIV recommends intravenous (IV) antibiotics therapy for patients with more severe clinical disease. However, the decision for treatment modality often depends o
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