Predicting the Need for a Surgical Intervention in the Management of a Tubo-Ovarian Abscess

Abstract

<h3>Study Objective</h3> To analyze the inpatient management of tubo-ovarian abscess (TOA) and identify factors associated with the need for a surgical intervention. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Community Hospitals with an Academic Affiliation. <h3>Patients or Participants</h3> Women who were managed inpatient with the diagnosis of a TOA between 2014-20 (N=77). <h3>Interventions</h3> TOA managed by intravenous (IV) antibiotics is effective in approximately 70% of patients. For those who fail IV antibiotics, drainage of the abscess is recommended, whether achieved by interventional radiologic means or surgery. We report on the management of TOA in patients who presented to our hospital system. Patients with TOA were identified by International Classification of Disease code N70.93. A confirmation of the diagnosis was made by chart review. Pertinent demographic, medical history, and clinical findings (i.e., abscess size, leukocytosis, fever and treatment) were abstracted from the medical record. <h3>Measurements and Main Results</h3> Descriptive statistics were used to characterize the cohort of patients. The mean age was 41.2 years (S.D. ± 11.12) and mean body mass index was 30.4 kg/m² (S.D. ±10.34). 43% of patients failed IV antibiotics and needed additional therapy. When analyzing data for factors associated with the need for additional therapy, we found that size (>5 cm) was a significant risk with odds ratio (95%CI) 9.423 (1.968- 45.116). When comparing findings amongst co-morbidities, race and ethnicity we found that there was a correlation between size and intervention but no statistical significance. <h3>Conclusion</h3> In our cohort, women with TOA greater than 5 cm were more likely to fail medical management. However, this association did not persist when controlling for other demographic and clinical factors. A larger recruited cohort may reveal a significance of size and the need for intervention. Consideration should be made for early consultation with a minimally invasive gynecologist or interventional radiologist to manage the TOA when there is an increased likelihood of failing medical management.