BACK TO BASICS: THE ACUTE ABDOMEN IN THE FIELD 5. What is the Expectation for Long-Term Outcome?


An understanding of the owner’s expectations can make a big difference in how to define long-term outcome. For example, if the expectation is solely to save the horse’s life, then considerations over incisional hernias or other long-term management problems such as laminitis can be more readily rec- onciled within the owner’s expectations. Long- term analyses based on the type of lesion a horse has had can also be discussed to make sure expectations are realistic. For example, once a horse has been discharged from the hospital, the long-term progno- sis is lower for horses with small intestinal stran- gulation obstruction as compared to other forms of obstruction.18 The principal reason for this ap- pears to be recurrent colic, most likely associated with adhesions.19 When advising owners, it is helpful for them to know that if a horse is going to have problems with adhesions, it is typically within 3 months of surgery. Unfortunately, colic that re- quires a second surgery because of adhesions carries a fair-to-guarded prognosis. If owners expect a return to athletic performance, management of long-term complications becomes that much more critical, and complications such as incisional hernia may require an additional surgery to enable athletic performance. Other surgical in- terventions that can potentially be performed to re- duce repeat colic that might require surgery are ablation of the nephrosplenic space in horses with repeat episodes of left dorsal displacement, and col- opexy in horses with repeat episodes of large colon volvulus. The latter tends to preclude athletic per- formance because of colic associated with adhesion of the colon to the ventral body wall, but is particu- larly useful in broodmares that are at greatest risk of large colon volvulus. Resection of the colon is an alternative consideration to colopexy, allowing re- turn to athletic performance. Larger studies to im- prove understanding of long-term outcome are needed, and beginning to be performed.


6. Helping Owners Return Their Horse to Performance


Return to intended use and performance following colic surgery is of major concern to horse owners. The potential for return to performance in an equine athlete is typically weighed against the cost of sur- gery, intensive post-operative care, and prolonged convalescence. In one published study on return to performance following colic surgery, 76% of horses discharged from the hospital had at least reached their pre-operative level of performance within 1 year.4 Another study on Thoroughbred racehorses showed that 69% of horses taken to surgery for colic returned to racing within 6 months.20 This illus- trates how long it can take to fully rehabilitate a horse following colic surgery. Current recommen- dations are to stall rest horses following discharge from the hospital for colic surgery for 1 month, fol- lowed by 1 month of small paddock turnout, and a


126 2020  Vol. 66  AAEP PROCEEDINGS


gradual return to exercise in the third month follow- ing colic surgery. This time frame approximately parallels the healing of the midline incision, which will have reached original strength in 8 weeks in the absence of any complications such as infection or repeat laparotomy.21 From this perspective own- ers can expect to be riding their horses at a reduced but escalating level after 2 months, with most sport horses attaining full athletic potential within 12 months, depending upon the discipline and extent of surgery.4 However, more recent studies on re- habilitation of horses with midline incisions suggest that practitioners could be advising clients differ- ently in order to return to performance more rapidly. In particular, a recent study showed that having clients work with their horses in a controlled fashion in the post-operative period to reduce loss of mus- cle strength reduced the time to return to full performance, and resulted in more horses attain- ing a higher level of performance following colic surgery.22


7. Conclusions


Preparing a client for the post-operative period fol- lowing colic surgery includes an understanding of short- and long-term complications. Once a horse has been discharged, the veterinarian should have the client focus on any instances of recurrent colic and the appearance of the incision. A good working knowledge of post-operative complications that oc- curred during hospitalization is important to be able to guide the client following hospital discharge. Finally, the post-operative exercise program should be carefully controlled to allow time for the midline incision to heal, but can be modified to reduce loss of muscle tone in order to increase the chances of ear- lier return to performance. Attention to feeding for optimal retention and strengthening of muscle mass is also an important component of post-operative rehabilitation.


Acknowledgments


Declaration of Ethics The Author has adhered to the Principles of Veteri- nary Medical Ethics of the AVMA.


Conflict of Interest The Author has no conflicts of interest.


References


1. Hackett ES, Embertson RM, Hopper SA, et al. Duration of disease influences survival to discharge of Thoroughbred mares with surgically treated large colon volvulus. Equine Vet J 2015;47:650–654.


2. Gonzalez LM, Fogle CA, Baker WT, et al. Operative factors associated with short-term outcome in horses with large colon volvulus: 47 cases from 2006 to 2013. Equine Vet J 2015;47: 279–284.


3. Freeman DE. Fifty years of colic surgery. Equine Vet J 2018;50:423–435.


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