Abstract
Aim
The aim of this paper was to study the characteristics of patients presenting to Middlemore Hospital with tubo-ovarian abscess (TOA) and to compare the outcomes of conservative medical management versus medical management with surgical drainage and medical management with radiological drainage.
Methods
All patients admitted with a radiologically or surgically proven TOA between January 01, 2008 and December 31, 2010, were included and followed up until June 30, 2011. The total number of patient/index admission was 174.
Results
The mean age of patients was 37.8 years. One hundred thirty patients had medical treatment only with hospitalization and antibiotics, and 44 patients were managed with antibiotics and surgical drainage. Complete resolution of TOA was 77.3% (99/128) for patients managed medically and 93.2% (41/44) for patients managed surgically. When the two groups were compared, patients who were managed surgically were more likely to have complete resolution of TOA within 6 months of index admission with an odds ratio (OR) of 4 and a P-value of 0.029. There was no statistically significant difference in the secondary outcomes namely of readmission with TOA (OR: 0.47) and the need for repeat surgical or radiological drainage (OR: 1.48). Nonetheless, the relative duration of hospitalization was longer for the surgical group with a P-value of <0.0001. The C-reactive protein and the size of TOA were the significant factors involved in the resolution of TOA.
Conclusion
The results of this study confirmed our initial hypothesis that we should consider surgical drainage more often, probably earlier, especially for the younger patients still desiring fertility preservation and for larger abscesses. Laparoscopic surgical drainage is safe and could be used as the procedure of choice. Conservative medical management is still acceptable with good cure rates of 77%. C-reactive protein and the size of the abscess were the important factors to consider when managing patients with TOA.
Acknowledgments
This study was supported by the Department of Obstetrics, Gynaecology, and Women’s Health, Middlemore Hospital, County Manukau District Health Board, Otahuhu, Auckland, New Zealand. The supervisor for this study was Lynsey Hayward, obstetrics and gynecology consultant at Middlemore Hospital. The study protocol was arranged with the assistance of Alain C Vandal, senior biostatistician at Center for Clinical Research and Effective Practice. Data analysis was performed by Christin Coomarasamy, data analyst, under the supervision of Vandal.
Disclosure
The author now works as an O&G Consultant at Waitemata District Health Board (WDHB); Waitakere Hospital, Auckland, New Zealand. The author reports no other conflicts of interest in this work.