A comparison of the Morbidities Associated with Different Early Treatments in Tubo-Ovarian Abscess Patients

OBJECTIVE: A tubo-ovarian abscess needs hospitalization and early treatment with parenteral antibiotics only or along with imaging-guided drainage. This meta-analysis juxtaposes between these interventions - the length of stay in hospital in days, surgery requirement for those not responding to the initial treatment, and readmission. STUDY DESIGN: The eligible papers searched in various databases (PubMed, Central, Embase, and Scopus) irrespective of their language or date of publication. The Joanna Briggs Institute's Critical Appraisal tool and Cochrane collaboration tool were used to appraise observational and randomized controlled trials, respectively. When a comparable outcome was reported from at least three studies of similar study design, they were included in the meta-analysis (fixed-effect model). Otherwise, outcomes were reported narratively. RESULTS: From 164 studies, five eligible papers (four non-randomized studies and one randomized controlled trials) were reviewed. These studies sourced data from 609 tubo-ovarian abscess patients. Overall, all studies had at least one unclear risk of bias components. The length of stay in the hospital among the tubo-ovarian abscess patients favored the initial parenteral antibiotic only treatment (WMD= -3.26; 95% CI= -4.93 to -1.58; p<0.001; I2=80.9%; p-value of Cochranes Q=0.005); however, on sensitivity analysis (meta-analysis with random-effect model) this difference disappeared. Less than three studies of a particular study design reported each of the remaining outcomes. CONCLUSION: The current evidence on how these outcomes vary between the juxtaposed interventions received by the tubo-ovarian abscess patients remains inconclusive due to the inadequate number of good quality randomized controlled trials