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Impact of early surgical management on tubo-ovarian abscesses.
J Obstet Gynaecol. 2020 Nov 28 [Online ahead of print]JO

Abstract

This 5-year retrospective study aimed to investigate whether early surgical management improves outcomes in patients presenting with a tubo-ovarian abscess (TOA). Patient characteristics, investigation results and treatment outcomes were compared. 50 women were diagnosed with a TOA during the study period. Nineteen (38.0%) were treated with antibiotics (medical group) and thirty one (62.0%) were treated surgically on admission (early surgical group). The early surgical group was associated with a high success rate of 96.8% and the lowest risk of readmission within 12 months (16.1%). There was no significant difference in the length of stay between the early surgical and the successful medical group. Impact Statement What is already known on this subject? Tubo-ovarian abscess (TOA) is an inflammatory mass that forms most commonly as a complication of untreated pelvic inflammatory disease (PID). Traditionally, TOAs are treated first with broad-spectrum intra-venous antibiotics, with surgical intervention considered after 72 h. It is not known whether early surgical intervention would be beneficial to patient outcomes compared to traditional management. What do the results of this study add? In this study, we have demonstrated a high success rate with early surgical management. Readmission rate was lowest in the early surgical group compared to the medical and late surgical group. This suggests that early surgical intervention may be beneficial, compared to the standard management of trialling antibiotics and then proceeding to surgery 72 h later. What are the implications of these findings for clinical practice and/or further research? Our study suggests that early surgery may be beneficial in the management of TOAs. Although we were unable to demonstrate statistical significance, our data suggest that it would be worthwhile to investigate white blood cell (WBC) and C-reactive protein (CRP) further as a potential predictor for failure of medical management. In the future, more studies comparing early surgical management with medical and late surgical management could inform clinicians of the best mode of treatment for these patients.

Authors+Show Affiliations

Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.QIMR Berghofer Medical Research Institute, Herston, Australia.Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia. Faculty of Medicine, The University of Queensland, Brisbane, Australia.Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia. Faculty of Medicine, The University of Queensland, Brisbane, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33249968

Citation

Zhu, Stephanie, et al. "Impact of Early Surgical Management On Tubo-ovarian Abscesses." Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology, 2020, pp. 1-5.
Zhu S, Ballard E, Khalil A, et al. Impact of early surgical management on tubo-ovarian abscesses. J Obstet Gynaecol. 2020.
Zhu, S., Ballard, E., Khalil, A., Baartz, D., Amoako, A., & Tanaka, K. (2020). Impact of early surgical management on tubo-ovarian abscesses. Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology, 1-5. https://doi.org/10.1080/01443615.2020.1821620
Zhu S, et al. Impact of Early Surgical Management On Tubo-ovarian Abscesses. J Obstet Gynaecol. 2020 Nov 28;1-5. PubMed PMID: 33249968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of early surgical management on tubo-ovarian abscesses. AU - Zhu,Stephanie, AU - Ballard,Emma, AU - Khalil,Akram, AU - Baartz,David, AU - Amoako,Akwasi, AU - Tanaka,Keisuke, Y1 - 2020/11/28/ PY - 2020/11/30/entrez PY - 2020/12/1/pubmed PY - 2020/12/1/medline KW - Tubo-ovarian abscess KW - laparoscopy KW - pelvic abscess KW - pelvic inflammatory disease KW - sexually transmitted infection SP - 1 EP - 5 JF - Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology JO - J Obstet Gynaecol N2 - This 5-year retrospective study aimed to investigate whether early surgical management improves outcomes in patients presenting with a tubo-ovarian abscess (TOA). Patient characteristics, investigation results and treatment outcomes were compared. 50 women were diagnosed with a TOA during the study period. Nineteen (38.0%) were treated with antibiotics (medical group) and thirty one (62.0%) were treated surgically on admission (early surgical group). The early surgical group was associated with a high success rate of 96.8% and the lowest risk of readmission within 12 months (16.1%). There was no significant difference in the length of stay between the early surgical and the successful medical group. Impact Statement What is already known on this subject? Tubo-ovarian abscess (TOA) is an inflammatory mass that forms most commonly as a complication of untreated pelvic inflammatory disease (PID). Traditionally, TOAs are treated first with broad-spectrum intra-venous antibiotics, with surgical intervention considered after 72 h. It is not known whether early surgical intervention would be beneficial to patient outcomes compared to traditional management. What do the results of this study add? In this study, we have demonstrated a high success rate with early surgical management. Readmission rate was lowest in the early surgical group compared to the medical and late surgical group. This suggests that early surgical intervention may be beneficial, compared to the standard management of trialling antibiotics and then proceeding to surgery 72 h later. What are the implications of these findings for clinical practice and/or further research? Our study suggests that early surgery may be beneficial in the management of TOAs. Although we were unable to demonstrate statistical significance, our data suggest that it would be worthwhile to investigate white blood cell (WBC) and C-reactive protein (CRP) further as a potential predictor for failure of medical management. In the future, more studies comparing early surgical management with medical and late surgical management could inform clinicians of the best mode of treatment for these patients. SN - 1364-6893 UR - https://www.unboundmedicine.com/medline/citation/33249968/Impact_of_early_surgical_management_on_tubo-ovarian_abscesses. L2 - https://www.tandfonline.com/doi/full/10.1080/01443615.2020.1821620 DB - PRIME DP - Unbound Medicine ER -
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