SIR 2024
Women's Health
Asmaa Khaled S Baothman, MD (she/her/hers)
PGY4 radiology resident
Ochsner Clinic Foundation
Financial relationships: Full list of relationships is listed on the CME information page.
Tyler Sandow, MD
Interventional Radiologist
Ochsner Health
Financial relationships: Full list of relationships is listed on the CME information page.
Comparing Use of Image-Guided Drainage versus Antibiotics Alone for the Management of TOAs
Materials and methods:
We performed a retrospective cohort analysis, approved by Ochsner IRB, of patients aged 18 years and above admitted to four hospitals in a large regional health system with the diagnosis of tubo-ovarian abscess from June 2017 to April 2023. Exclusion criteria included those with suspected TOA rupture and those with absolute contraindications to percutaneous drainage. Baseline clinical characteristics were extracted from electronic medical records. Patients were classified as either initial percutaneous drainage plus intravenous antibiotics, or postponed (48 hours after antibiotic initiation) drainage plus antibiotics and antibiotics alone. Propensity score matching produced cohorts evenly matched on age, body mass index, history of diabetes and TOA diameter. Primary outcome was length of stay. Secondary outcomes included readmission rates and need for surgical intervention.
Results:
Among 105 patients, 28 (27%) were managed with immediate percutaneous drainage. Despite matching on TOA diameter, more abscesses in the immediate intervention group measured > 7cm (76% vs 24 %, p=0.003); baseline characteristics were otherwise similar. There were no differences in length of stay (85 vs 95 hours, p=0.956) or readmission rates. Those receiving initial drainage were less likely to require subsequent surgical intervention (24% vs 56%, p=0.021).
Conclusion:
Initial drainage of TOAs reduce the need for surgical intervention and associated morbidity, though no difference in length of stay was observed.