EQUINE VETERINARY EDUCATION / AE / JANUARY 2017
33
Original Article
Time-related changes in post-operative equine morbidity: A single-centre study
K. J. Borland*, D. J. Shaw and R. E. Clutton Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Roslin, UK. *Corresponding author email:
Borland.karla@gmail.com
Keywords: horse; anaesthesia; morbidity; post operative
Summary Our objective was to test the hypothesis that the prevalence and type of post-operative equine morbidity at a single centre does not change over time with a retrospective and prospective observational study. The post-operative case records of 92 (of 96) horses undergoing nonabdominal procedures, and surviving to discharge, were compared with previous data from the same centre. Predefined morbidities were recorded from horses undergoing surgery between August 2013 and July 2014. This was compared with data collected from the same institute from April 2004 to June 2005 and published in a previous study. The overall prevalence of morbidities increased from 13.4% to 25%. The prevalence of post-anaesthetic colic, thrombophlebitis, pyrexia, lameness, neuropathy and myopathy increased while the proportion of incidence of diarrhoea, respiratory distress and wounds sustained in recovery decreased. There was a statistically significant association (P = 0.045) between the duration of surgery and the prevalence of post-anaesthetic colic. Geldings were less likely (odds ratio 0.12, 95% confidence interval 0.02–0.84) to develop swelling at the catheter site and the likelihood of thrombophlebitis increased by 1.20 (95% confidence interval 1.01–1.41) for every year of life. Tracking morbidities and changes in their prevalence may elucidate their possible causation and allow prophylactic measures to be taken.
Introduction
Post-operative morbidities in horses prolong convalescence and increase hospitalisation costs (Bennett-Guerrero et al. 1999). Mild complications may resolve spontaneously and inconsequentially; severe morbidities may cause permanent lesions, precipitate natural death, or necessitate euthanasia on medical, humane or economic grounds. Critical incident reporting and identification of factors
influencing post-operative morbidities have been recognised as essential in human medicine (Smith and Mahajan 2009; Bolsin et al. 2010; Tewari and Sinha 2013) and the recording of post-operative morbidities is a requirement of the Royal College of Veterinary Surgeons (RCVS 2010). The prevalence of post-operative equine morbidities is
sparsely described. Young and Taylor included information on anaesthetic-related problems in 19/1314 horses following general anaesthesia for nonabdominal procedures, almost all of whom suffered from myopathy (Young and Taylor 1993). The third confidential enquiry into post-operative equine fatalities described nonfatal complications but did not classify these beyond myopathies (Johnston 2005).
A previous multicentre study (Senior et al. 2007) examined
the prevalence of several morbidities affecting horses undergoing nonabdominal surgery, between April 2004 and June 2005, in 4 equine hospitals including the Royal (Dick) School of Veterinary Studies, which provided data from 194 anaesthetics. The principal problems identified in this study, in the first 72 h after recovery from anaesthesia, were post- anaesthetic colic (PAC) and prolonged recovery (7.7% and 3% respectively). Over time, putative risk factors may change (e.g. yard
and clinical staff, horse population characteristics) producing corresponding changes in the prevalence of morbidities. There is an expectation that morbidity rates should decrease over time with ongoing improvements in clinical practice. The purpose of the current study was to test the (null) hypothesis that the prevalence and type of morbidity at a single centre do not change over time.
Materials and methods
After approval from the Veterinary Ethical Review Committee of the Royal College of Veterinary Surgeons (2014) the proportion of horses suffering from predefined morbidities (Table 1), arising between recovery from anaesthesia and hospital discharge, were recorded from horses undergoing nonabdominal surgery between August 2013 and July 2014. These data were then compared with data collected at the same institute from April 2004 and June 2005 that had been incorporated into the multicentre study of Senior et al. (2007). During both periods, animal characteristics (bodyweight,
age, breed and sex) and pertinent case information (duration of hospitalisation, surgical categorisation e.g. orthopaedic vs. soft tissue) of animals surviving surgery was entered into a database. The surgery performed was briefly noted e.g. arthroscopy, laryngoplasty. Details of post- operative equine morbidities were gleaned from each animal’s clinical case notes and the anaesthetic record. Further details were collected during post-operative rounds when the cases were discussed. Two populations were defined for analysis: 2013–14 and
2004–2005 (Senior et al. 2007). Data from horses experiencing prolonged recoveries (recumbency lasting >30 min per hour of anaesthesia time) were not analysed in the current study unless extraordinary interventions, e.g. slinging, were required (Senior et al. 2007).
Statistical analysis Statistical analyses were performed using Minitab (version 16.0 for Windows)1. Comparisons were made to detect
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