Is it possible to estimate the need for surgical management in patients with a tubo-ovarian abscess at admission? A retrospective long-term analysis

Abstract

Background This study aimed to determine the possible prognostic factors correlated with the treatment modalities of tubo-ovarian abscesses (TOAs) and thus to assess whether the need for surgery was predictable at the time of initial admission. Materials and methods Between January 2012 and December 2019, patients who were hospitalized with a TOA in our clinic were retrospectively recruited. The age of the patients, clinical and sonographic presentation, pelvic inflammatory risk factors, antibiotic therapy, applied surgical treatment, laboratory infection parameters, and length of hospital stay were recorded. Results The records of 115 patients hospitalized with a prediagnosis of TOA were reviewed for the current study. After hospitalization, TOA was ruled out in 19 patients, and data regarding 96 patients was included for analysis. Twenty-eight (29.2%) patients underwent surgical treatment due to failed antibiotic therapy. Sixty-eight (70.8%) were successfully treated with parenteral antibiotics. Medical treatment failure and need for surgery were more common in patients with a large abscess (volume, > 40 cm3, or diameter, > 5 cm). The group treated by surgical intervention was statistically older than the patients receiving medical treatment (p < 0.05). Conclusions Although the treatment in TOA may vary according to clinical, sonographic, and laboratory findings; age of patients, the abscess size, and volume were seen as the major factors affecting medical treatment failure. Moreover, TOA treatment should be planned on a more individual basis.

Risk factors for antibiotic therapy failure in women with tubo‐ovarian abscess: A systematic review and meta‐analysis

“…The other cutoff values reported for age were 40 years (55.7% sensitivity, 63.1% specificity), 11 41.5 years (71.3% sensitivity, 60% specificity), 27 and 34.3 years (93.8% sensitivity, 35% specificity) 28 . In the other studies that did not report the receiver operating characteristics curve analysis results, many of the women who underwent surgical therapy were older than 40 years of age 4,6,7,9,10,17,21,22,29,31 . The reported cutoff values of abscess size for surgical therapy need varied between the 5 and 7.4 cm with the sensitivity of 60.5%–89% and the specificity of 50%–92% 7,8,10,11,16–18,21–23,26–28,31,32 .…”

“…Study characteristics presented in Table 1 were extracted by four authors independently 4–32 . The fifth author reviewed the extracted data.…”

Pelvic abscess – to drain or not to drain?

“…The authors stress that the size of pelvic abscess is the most important predictor as to whether surgery will be required (cut off of ≥7 cm). Gözüküçük et al [16 ▪ ] performed a retrospective study (96 pelvic abscess patients) over 7 years to assess factors at presentation, which may predict who will require surgical intervention; factors predicting failure of medical treatment were older age of patients, size of pelvic abscess (>5 cm) and pelvic abscess volume (> 40 cm 3 ).…”

Tuboovaryan apseli hastalarda sistemik inflamatuvar belirteçlerin medikal tedavi başarısızlığını öngörmedeki yeri

“…Yaş, apse boyutu, başvuru anındaki lökosit sayısı ve bilateraliteyi içeren bir skorlama sistemi hazırlayan Folks ve ark. 'ı cerrahi tedaviyi yüksek olasılıkla öngördüklerini bildirmişlerdir (19). Yaş, apse boyutu ve beyaz küre sayısının medikal tedavi başarısızlığını yüksek oranda gösterdiği bildiren başka çalışmalarda bulunmaktadır (19)(20)(21)(22)(23)…”

“…'ı cerrahi tedaviyi yüksek olasılıkla öngördüklerini bildirmişlerdir (19). Yaş, apse boyutu ve beyaz küre sayısının medikal tedavi başarısızlığını yüksek oranda gösterdiği bildiren başka çalışmalarda bulunmaktadır (19)(20)(21)(22)(23)…”