Risk Factors for Complicated Tubo-Ovarian Abscess Surgery

To identify clinical, laboratory, radiologic, and operative factors associated with intraoperative complications during surgical management of tubo-ovarian abscess (TOA), and to describe evolving surgical trends over a 10-year period.

This retrospective cohort study included 177 women who underwent operative treatment for TOA between January 2015 and June 2025 at a tertiary referral center. Demographic variables, laboratory parameters, radiologic findings, operative details, and postoperative outcomes were extracted from institutional records. Patients were grouped as uncomplicated or complicated according to the presence of bowel, bladder, or ureteral injury. Groups were compared using appropriate statistical tests.

Of 177 patients, 9 (5.1%) experienced intraoperative organ injury. Complicated cases were significantly older (49 vs 42 years, P = .006) and exhibited higher C-reactive protein (CRP) levels (299 vs 188 mg/L, P = .004), higher platelet counts (544,000 vs 351,000/µL, P = .002), elevated platelet-to-lymphocyte ratio (PLR) (240.9 vs 186.8, P = .010), and lower mean platelet volume (MPV) (7.80 vs 8.70 fL, P = .019). Abscess size and bilaterality were not associated with complications. Extensive surgery was more frequently performed in the complicated group. A pronounced shift toward minimally invasive surgery was observed, with laparoscopy becoming the predominant approach after 2023 and all cases in early 2025 performed laparoscopically. Complicated surgeries were associated with longer operative times, greater postoperative hemoglobin decline, prolonged hospitalization, and markedly higher reoperation rates.

Older age, elevated inflammatory markers, and altered platelet indices may help identify patients at increased risk of operative difficulty. The growing use of laparoscopy supports its role as a feasible and increasingly preferred surgical approach in the management of TOA.