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

Abstract

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.