Indications, complications, and outcome of horses undergoing repeated celiotomy within 14 days after the first colic surgery: 95 cases (2005–2013)

• Autores: Bettina Dunkel
• Localización: JAVMA: Journal of the American Veterinary Medical Association, ISSN-e 0003-1488, Vol. 246, Nº. 5, 2015, págs. 540-546
• Idioma: inglés
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• Resumen

  • Objective—To examine factors associated with short- and long-term prognosis for horses undergoing repeated celiotomy within 14 days after the first colic surgery.

    Design—Retrospective case series.

    Animals—95 horses that had undergone 2 celiotomies within a 14-day period between 2005 and 2013 at 3 equine referral hospitals.

    Procedures—Historical, clinical, and laboratory data were compared between horses that did not survive and horses that did survive to hospital discharge (short-term survival rate) and to > 3 and > 6 months after hospital discharge (long-term survival rates).

    Results—Strangulating small intestinal lesions were the most common finding during the first celiotomy (60/95 [63.2%]), and persistent gastric reflux was the most common reason for the second celiotomy (56/95 [58.9%]). Reasons for a second celiotomy were not associated with survival rate. For horses that had long-term follow-up, 22 of 92 (23.9%) survived > 6 months after hospital discharge. Two of 13 horses with intestinal resections during both surgeries survived to > 6 months after hospital discharge. Compared with horses not undergoing intestinal resection, significantly fewer horses requiring resection during 1 or both surgeries survived to hospital discharge and to > 3 and > 6 months after hospital discharge. Incisional infections occurred in 68.4% (26/38) of horses that survived to hospital discharge, and 31.6% (12/38) developed incisional hernias or dehiscence.

    Conclusions and Clinical Relevance—Results indicated that the prognosis for horses undergoing repeated celiotomy is guarded, and intestinal resection negatively affects the long-term survival rate.

    Indications, complications, and prognosis for horses undergoing exploratory colic surgery for a variety of conditions have been extensively described.1–9 Although the quality of care and rate of survival to hospital discharge for horses undergoing colic surgery have increased over the past decades and are now generally considered good, several complications can occur during the immediate postoperative period, which influence short- and long-term outcome.5,10 Postoperative ileus and recurring colic are considered the most commonly encountered problems and, if severe or unrelenting, might require a second celiotomy shortly after the first procedure. Little information is available about horses requiring a second abdominal surgery shortly after the first procedure; to our knowledge, only 1 study11 has focused on this population specifically. That 2005 study,11 performed at a single equine referral hospital, included 27 horses undergoing repeated celiotomy within 14 days of the first celiotomy and reported a low long-term survival rate of 22.2%.

    Whereas the financial and emotional impact encountered by the client is substantial, an accurate estimation of short- and long-term survival rates appears important but larger-scale studies investigating outcome are lacking. The purpose of the study reported here was to describe indications, findings, complications, and prognosis for horses undergoing 2 abdominal surgeries for colic within a 14-day period and to compare data between those that did not survive and those that survived in the short and long term. We hypothesized that horses undergoing repeated celiotomy because of persistent gastric reflux would have a worse short-term prognosis than horses undergoing repeated celiotomy for other reasons and that the requirement for intestinal resection and anastomosis during the first or second celiotomy would influence the long-term outcome negatively.