The prediction of surgical intervention in patients with tubo-ovarian abscess

Hwang, Jong Ha; Kim, Bo Wook; Kim, Soo Rim; Kim, Jang Heub

doi:10.1080/01443615.2020.1867965

Cited by 6 publications

(10 citation statements)

References 15 publications

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“…Recommendations for drainage may be strengthened in cases of leukocytosis as our logistic regression modeling noted the independent association of increasing white blood cell count with failure of primary medical management. This nding is supported by three previous studies noting a similar association, citing a threshold of 15x10 3 /uL across all studies [12,[15][16][17].…”

Section: Discussionsupporting

confidence: 84%

Tuboovarian Abscess Treatment Outcomes at an Academic Safety Net Hospital in Los Angeles, California

Lee

Novatt

Sripras

et al. 2022

Preprint

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Purpose: To identify patient factors associated with medical management failure and hospital readmission among patients admitted with a diagnosis of tuboovarian abscess at a public hospital in Los Angeles, California. Methods: We conducted a retrospective chart review of admissions for tuboovarian abscess from January 2014 through August 2019, describing treatment plans and their subsequent outcomes. Patient factors associated with failure of medical management, as defined by requiring image-guided drainage or surgery, and hospital readmission were identified via bivariate analyses, using Chi-square, Fisher’s exact, and Wilcoxon signed-rank tests as appropriate. Factors independently linked to failure of medical management were determined via logistic regression. Results: We treated 147 patients with tuboovarian abscess over 5 years, comprised primarily of Hispanic/Latinx (74%; n=109/147) women, median age 39 (range: 18-70) years. The median abscess size was 6.3cm (range: 4.8-8.0). Only 16% (n=23/147) who initially received parenteral antibiotic therapy failed medical management. Factors independently and positively linked to parenteral antibiotic failure included elevated white blood cell count (aOR 1.17; 95%CI 1.04-1.32) and abscess size (aOR 1.07; 95%CI 1.04-1.10). No tuboovarian abscesses under 5.5 centimeters required procedural intervention when treated with parenteral antibiotics alone. We identified rehospitalizations among 13.6% (n=20/147) of patients; no factors were significantly linked to rehospitalization.Conclusions: Tuboovarian abscesses were successfully treated with medical management in more than 80% of cases. Early procedural intervention for tuboovarian abscesses greater than 5.5 centimeters in diameter may help to avoid short and long-term morbidities.

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Section: Discussionsupporting

confidence: 84%

Tuboovarian Abscess Treatment Outcomes at an Academic Safety Net Hospital in Los Angeles, California

Lee

Novatt

Sripras

et al. 2022

Preprint

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“…Fouks et al also found no added value for mean CRP values at admission, even after multivariate analysis (15). Hwang et al reported that although WBC, CRP, and ESR levels were statistically significantly higher in the surgical intervention group than in the conservative treatment group in the univariate analysis, only ESR was significant in multivariate analysis (23). Similarly, in our study, the mean CRP level in univariate analysis was significantly higher in the surgical intervention group (205±109 mg/L) than in the conservative treatment group (115±90 mg/L).…”

Section: Discussionmentioning

confidence: 98%

“…Presenting symptoms and signs of patients One patient was excluded because she was a virginwas observed between treatment type and NLR in the correlation analysis(25). Hwang et al found that NLR had only borderline significance in the univariate analysis(23).Levin et al …”

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confidence: 99%

Can the Risk Factors Predicting Surgical Treatment be Determined in Patients with Tubo-Ovarian Abscess?

Vural

Bayraktar

Karaca

et al. 2022

Gynecol Obstet Reprod Med

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OBJECTIVES: In this study, we aimed to determine the risk factors in predicting the need for surgical treatment due to medical treatment failure in patients with tubo-ovarian abscess. STUDY DESIGN: This is a retrospective cohort study performed in a university hospital between 2015 and 2020. Sixty-nine patients with tubo-ovarian abscess were treated with parenteral antibiotics. Some of them required surgery because antibiotic treatment was not successful. We compared the group in which parenteral antibiotic treatment was successful with the group that required surgical treatment. The conservative treatment group consisted of 43 (62.3%) patients who responded to antibiotic therapy alone (gentamicin-clindamycin), and the operation group consisted of 26 women (37.7%) who did not reply to antibiotic therapy and required operation. Demographic, clinical, sonographic, and laboratory results were compared between the two groups using univariate and logistic regression analyses. RESULTS: Overall, up to 37.7% (26/69) of the patients underwent surgery after failure of antibiotic therapy. Patients who failed antibiotic therapy had higher infection parameters such as C-reactive protein (205±109 mg/dL vs. 115 ± 90 mg/dL, p=0.002), platelet count (349 ± 108 x 103/mm3 vs. 298 ± 95 x 103/mm3, p=0.042), and neutrophil-to-lymphocyte ratio (18.8 ± 35.7 vs. 8.2 ± 6.9, p=0.022). Also in the same group, larger tubo-ovarian abscess size (61.6±16.6 mm vs 45.8 ± 10.3 mm, p<0.001) and more frequent intrauterine device use (46.2% vs 16.3%, p=0.007) were observed. But none of them (C-reactive protein, neutrophil-to-lymphocyte ratio, tubo-ovarian abscess size, presence of an intrauterine device) was found to be a significant independent factor in anticipating conservative treatment failure of tubo-ovarian abscess in logistic regression analysis. CONCLUSION: Although helpful in diagnosis, none of the demographic, sonographic, or laboratory parameters can predict surgical treatment in women with tubo-ovarian abscess.

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“…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][17][18][21][22][23][26][27][28]31,32 In all studies included in the meta-analysis, the mean abscess size was larger than 5.9 cm in the surgical therapy groups. In the light of these knowledge, it could be considered that the surgical therapy need is higher in women older than 40 years of age and with the abscess size larger than 6 cm.…”

Section: Discussionmentioning

confidence: 99%

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

Section: Methodsmentioning

confidence: 99%

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

Kinay,

Akay,

Aksoy

et al. 2024

J of Obstet and Gynaecol

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AimMedical therapy with antibiotics only and surgical drainage are the treatment options of tubo‐ovarian abscess (TOA). It is not yet known exactly which cases need surgical treatment. The aim of this systematic review and meta‐analysis was to evaluate the risk factors leading antibiotic therapy failure in women with TOA.MethodsWe searched the following databases from inception to June 1, 2022: PubMed, Ovid MEDLINE, The Cochrane Library, and Scopus. We also searched reference lists of eligible articles and related review articles. The observational cohort, cross‐sectional, and case–control studies were included in the meta‐analysis. At least four review authors independently selected eligible articles, assessed risk of bias, and extracted data. The random effect model was used in the meta‐analysis.ResultsA total of 29 studies, including 2890 women, were included in the study. The age, abscess size, history of intrauterine device use, postmenopausal status, history of diabetes mellitus, fever, white blood cell count, erythrocyte sedimentation rate, C‐reactive protein level, and history of pelvic inflammatory disease were found as significant risk factors for antibiotic therapy failure in women with TOA.ConclusionsThe findings of this study clarified the risk factors for antibiotic therapy failure in women with TOA.

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The prediction of surgical intervention in patients with tubo-ovarian abscess

Cited by 6 publications

References 15 publications

Tuboovarian Abscess Treatment Outcomes at an Academic Safety Net Hospital in Los Angeles, California

Tuboovarian Abscess Treatment Outcomes at an Academic Safety Net Hospital in Los Angeles, California

Can the Risk Factors Predicting Surgical Treatment be Determined in Patients with Tubo-Ovarian Abscess?

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

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