title: Tuboovarian abscess. Factors associated with operative intervention after failed antibiotic therapy.
abstract: OBJECTIVE
  To evaluate whether size of tuboovarian abscess (TOA) and other clinical characteristics were associated with the need for surgical intervention.
  
  
  METHODS
  A retrospective chart review of patients hospitalized at an inner city hospital between January 1998 and December 2007 with the diagnosis of TOA. Demographics, medical history, clinical markers of infection, radiology, pathology, and operative reports were examined. Student's t test and Fisher's exact test were utilized to analyze differences between groups. Multiple logistic regression analysis was performed to identify significant predictors of surgery. Receiver operating characteristic (ROC) analysis was used to assess how well TOA size and other significant variables were associated with the need for operative or procedural intervention.
  
  
  RESULTS
  A total of 163 patients with TOA were identified; 41 patients were excluded based on specific criteria. Of the remaining 122 women, 65.6% responded to antibiotic therapy, and 34.4% had surgery or ultrasound-guided drainage. Mean TOA size in the medical group was 4.4 cm as compared to 7.3 cm in the surgical group (p < 0.0001). Maximal leukocyte count, older age, and parity were associated with significantly higher risk of surgery. The significant univariate variables remained significant after multivariate analysis. ROC curve analysis revealed an excellent discrimination of the need for surgical treatment as predicted by TOA size, with increased likelihood of surgical or procedural intervention with increasing TOA size.
  
  
  CONCLUSIONS
  Radiographic size, leukocyte count, age, and parity are associated with operative or procedural treatment of tuboovarian abscess.
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Santa Clara, California, USA.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Greenstein
authors.forename: Ami J
authors.initials: AJ
authors.lastname: Shah
authors.forename: Olivera
authors.initials: O
authors.lastname: Vragovic
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.forename: Valena
authors.initials: V
authors.lastname: Soto-Wright
authors.forename: Lynn
authors.initials: L
authors.lastname: Borgatta
authors.forename: Wendy
authors.initials: W
authors.lastname: Kuohung
mesh_terms: D000038:Abscess / Q000097:blood / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D005184:Fallopian Tube Diseases / Q000097:blood / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007958:Leukocyte Count; D016015:Logistic Models; D010049:Ovarian Diseases / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D010052:Ovariectomy; D010298:Parity; D012372:ROC Curve; D012189:Retrospective Studies; D058994:Salpingectomy; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents