Management of a Tubo-Ovarian Abscess: A Single-Centre Retrospective Cohort Study of Clinical Outcomes and Factors Associated With Failure of First-Line Medical Therapy

Objective: To describe the clinical characteristics, antibiotic management, and outcomes of a consecutive cohort of women admitted with tubo-ovarian abscess (TOA) and to determine the factors associated with failure of first-line medical therapy.Design and setting: This is a retrospective cohort study, with the setting of the Gynaecology Department at the University Hospitals of Leicester, United Kingdom.Population: A total of 61 women who had a working diagnosis of TOA were identified during the study period; 14 (23%) were excluded when an alternative final diagnosis was made, and a further three women were excluded due to incomplete outcome documentation, so 44 women with a confirmed diagnosis of TOA remained for analysis.Methods: Demographic data, together with the microbiological, radiological, antibiotic, and procedural data, were systematically extracted from clinical records and coded.The outcomes were compared between women whose abscess resolved with antibiotics alone and those who required radiological or surgical drainage, using Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables.Main outcome measures: These are the success of first-line antibiotic therapy, need for image-guided or surgical drainage, and length of hospital stay (LOS).Results: Median age was 41 years (IQR: 33.5-51), and median BMI was 28 kg/m² (IQR: 24-32.5).Among the 44 women with complete documented treatment outcomes, antibiotics alone were successful in 31 (70.5%), while 13 (29.5%)required further treatment with image-guided drainage or surgery.Procedures included image-guided drainage (n = 2), laparoscopic drainage or definitive laparoscopic surgery (n = 5), laparoscopic surgery converted to laparotomy (n = 3), and primary laparotomy (n = 3).A prior history of pelvic inflammatory disease (PID) (62% vs 3%, p < 0.001), previous admission with TOA (46% vs 13%, p = 0.043), and an abscess diameter >6.5 cm (64% vs 25%, p = 0.033) were each significantly more common among women whose medical management failed.LOS was also significantly longer in women who failed medical therapy (median 6 vs 4 days, p = 0.030).Almost a quarter (23%) of women initially coded as TOA (14/61 excluded cases) ultimately had an alternative diagnosis established on imaging, most commonly hydrosalpinx or salpingitis.Conclusions: First-line antibiotic therapy resolved TOA in approximately 7 of 10 women with a documented treatment outcome in this cohort, which is in keeping with contemporary published series.Recurrent disease, a prior history of PID, and larger abscess diameter identify women at higher risk of failing medical therapy and may help target earlier senior/multidisciplinary review and consideration of early drainage.