Associated Factors with Failed Response to Conservative Treatment in Tubo-Ovarian Abscess
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Abstract
Background: Tubo-Ovarian abscess is a complication of acute pelvic inflammatory disease. Primary treatment for this condition is usually conservative with the use of antibiotics. Patients who do not respond to antibiotics require surgery in adjunct. Clinical factors associated with failed response to conservative treatment in Tubo-Ovarian abscess have not been confirmed yet. The researcher is interested in investigating the factors associated with failed response to conservative treatment in Tubo-Ovarian abscess.
Objective:
1. To assess the factors associated with failed response to conservative treatment in Tubo-Ovarian abscess.
2. To derive the prediction of failed response to conservative treatment in patients with Tubo-Ovarian abscess.
3. To validate the results from the derivation phase.
Design: A retrospective analytical study
Setting: Department of Obstetrics and Gynecology, Maharat Nakhon Ratchasima Hospital
Methods and materials: The study were designed to have 2 phases; derivation and validation. Derivation phase collects data of the patients who were diagnosed with Tubo-Ovarian abscess admitted into Maharat Nakhon Ratchasima Hospital during January 2007 and December 2009. Patients were divided into 2 groups, those requiring surgery due to failed response to conservative treatment and the control group receiving only conservative treatment. Multiple logistic regression analysis was used to find the factors associated with failed response to conservative treatment in Tubo-Ovarian abscess and to quantify the probability of requiringsurgery in adjunct. Validation phase is used to verify the failure rate of conservative treatment predicted by the derivation phase in patients admitted into Maharat Nakhon Ratchasima Hospital during January and June 2010.
Results: During the study, 132 patients were admitted into Maharat Nakhon Ratchasima Hospital with Tubo-Ovarian abscess, 113 patients were included in the study. There were 38.9% of patients failed response to conservative treatment. Using multiple logistic regression analysis, those patients had two significant clinical factors, the size of the abscess and the inflammation of the pelvic peritoneum. Using the collected data to derive the prediction for the result of conservative treatment showed that patients scoring in the low, moderate and high risk groups have 8.3%, 43.6% and 88.5% chance of requiring surgery for treatment respectively. During the validation phase, patients in the low, moderate and high risk groups had 15.4%, 33.3% and 100% chance of requiring surgery for treatment respectively. There are no significant difference of the percentage of patients requiring surgery for treatment between the derivation and validation phases.
Conclusions: The diameter of the abscess and the inflammation of the pelvic peritoneum are factors associated with failed response to conservative treatment in Tubo-Ovarian abscess. Patients with > 7cm. with pelvic peritonitis have a 90% chance of requiring surgery for treatment.
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References
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