Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo-ovarian abscesses



Management of tubo-ovarian abscesses (TOA) is often complex and may include antibiotics, image-guided drainage via interventional radiology (IR) or surgery. We aim to (i) identify clinical factors that prognosticate primary drainage and (ii) compare outcomes of each treatment regimen.


This is a retrospective analysis on patients with TOA, admitted to KK Hospital, a tertiary women’s hospital in Singapore from June 2016 to June 2017. Pregnant patients or patients who were discharged against medical advice were excluded. 102 patients were included in this study.


85.3% patients received antibiotics only, while 14.7% patients received antibiotics with IR drainage or surgery (primary drainage) as initial treatment. Subsequently, 20.7% failed antibiotic treatment and required IR drainage or surgery (secondary drainage). Patients aged above 40 years, TOA diameter of larger than 7 cm and presence of fever were found to be predictive of antibiotic failure, requiring secondary drainage. However, patients with primary drainage had a longer length of stay by 2.69 days (95% CI 1.44–3.94, p value < 0.001), compared to patients successfully managed conservatively.


Patients who are above 40 years, febrile and have a larger TOA are at a higher risk of medical treatment failure, and should, therefore, be recommended for primary drainage at presentation. Further prospective studies should be conducted with a larger sample size to compare the outcomes of conservative management versus drainage of TOA.

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We would like to acknowledge Dr. Ong Chiou Li and Dr. Luke Toh Han Wei, from the Department of Diagnostic Imaging, KK Women’s and Children’s Hospital, for their guidance on the development of the study design.

Author information




TTCW contributed to the development of the research design, data collection, statistical analysis and drafting of the manuscript. HCQL contributed to the development of the research design, data collection, statistical analysis, and editing of the manuscript. TTC contributed to the development of the research design and analysis strategy, and provided editorial guidance for this manuscript. All authors approved this version of the manuscript for submission.

Corresponding author

Correspondence to Tiffany Tuck Chin Wong.

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The authors declare that they have no conflict of interest.

Ethical approval

An ethics board approval for the study was obtained from the Singhealth Centralised Institutional Review Board with the reference number 2017/2816. This article does not contain any studies with human participants or animals performed by any of the authors.

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Wong, T.T.C., Lau, H.C.Q. & Tan, T.C. Retrospective study on the efficacy and prognostic factors of conservative versus drainage of tubo-ovarian abscesses. Arch Gynecol Obstet (2020).

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  • Tubo-ovarian abscess
  • Image-guided drainage
  • Surgical drainage
  • Surgery
  • Conservative treatment
  • Antibiotics treatment