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Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo-ovarian abscesses.
Arch Gynecol Obstet. 2020 09; 302(3):679-683.AG

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.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. tiffany.wong@mohh.com.sg.Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32535665

Citation

Wong, Tiffany Tuck Chin, et al. "Retrospective Study On the Efficacy and Prognostic Factors of Conservative Versus Drainage of Tubo-ovarian Abscesses." Archives of Gynecology and Obstetrics, vol. 302, no. 3, 2020, pp. 679-683.
Wong TTC, Lau HCQ, Tan TC. Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo-ovarian abscesses. Arch Gynecol Obstet. 2020;302(3):679-683.
Wong, T. T. C., Lau, H. C. Q., & Tan, T. C. (2020). Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo-ovarian abscesses. Archives of Gynecology and Obstetrics, 302(3), 679-683. https://doi.org/10.1007/s00404-020-05640-0
Wong TTC, Lau HCQ, Tan TC. Retrospective Study On the Efficacy and Prognostic Factors of Conservative Versus Drainage of Tubo-ovarian Abscesses. Arch Gynecol Obstet. 2020;302(3):679-683. PubMed PMID: 32535665.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo-ovarian abscesses. AU - Wong,Tiffany Tuck Chin, AU - Lau,Hester Chang Qi, AU - Tan,Thiam Chye, Y1 - 2020/06/13/ PY - 2019/10/30/received PY - 2020/06/06/accepted PY - 2020/6/15/pubmed PY - 2020/10/28/medline PY - 2020/6/15/entrez KW - Antibiotics treatment KW - Conservative treatment KW - Image-guided drainage KW - Surgery KW - Surgical drainage KW - Tubo-ovarian abscess SP - 679 EP - 683 JF - Archives of gynecology and obstetrics JO - Arch Gynecol Obstet VL - 302 IS - 3 N2 - 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. SN - 1432-0711 UR - https://www.unboundmedicine.com/medline/citation/32535665/Retrospective_study_on_the_efficacy_and_prognostic_factors_of_conservative_versus_drainage_of_tubo-ovarian_abscesses. L2 - https://dx.doi.org/10.1007/s00404-020-05640-0 DB - PRIME DP - Unbound Medicine ER -