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EQUINE VETERINARY EDUCATION / AE / JANUARY 2017
TABLE 1: Definitions of post-operative equine morbidities identified in previous and current studies (Tinker et al. 1997; Senior et al. 2007) Morbidity
Definition Thrombophlebitis
Inflamed vein with in vivo blood clot formation. Diagnosis on basis of physical signs (venous hardening, redness, warmth and/or pain), or ultrasonography.
Dyspnoea/respiratory obstruction Upper airway lesion necessitating intervention e.g. tracheostomy. Pulmonary oedema
Lameness, muscle damage, neuropathy
Post-operative colic in (previously) noncolic cases
Pyrexia Diarrhoea Wound infection
Signs of coughing, wheezing, rales on thoracic auscultation with pink frothy fluid appearing at the nares or mouth, identified on endoscopy or at post-mortem examination.
Inability to bear equal weight on all 4 limbs. Painful, swollen muscles, myoglobinuria, creatinine kinase values >15,000 iu/L. Neurological deficits causing lameness or muscle weakness.
Any recognised sign of abdominal pain, for example, pawing the ground, kicking the abdomen, attempts to lie down (Tinker et al. 1997). Rectal temperature >39°C
Soft or liquid faeces with increased volume and frequency. Seropurulent or purulent discharge at surgical site necessitating swabbing for culture and sensitivity.
differences between groups for age, bodyweight, sex, elective or emergency status, and anaesthesia time. Anaesthesia time was defined as the time from induction of anaesthesia until the horse was moved into the recovery box. A value of P<0.05 was considered statistically significant. Each of the categories were examined for normality of distribution using a probability plot of the data. Bodyweight, time for hospitalisation and age were not normally distributed in comparison to anaesthesia time. A Mann–Whitney test was used to examine the nonparametric data (age and bodyweight) while a 2 sample t test was used to compare anaesthesia time between groups. A v2 test was used to analyse sex and elective-emergency status differences. Statistical analysis of changes in morbidity prevalence were carried out using a v2 test. The prevalence of morbidities was analysed using binary
logistic regression to determine if case background or procedure status (i.e. emergency/elective, duration of surgery, age, bodyweight or time in the hospital) had any significant association with the individual morbidities. A 2 stage process was adopted. First, univariate analyses of individual variables was carried out. Second, multivariable analyses were conducted to establish if combined factors e.g. sex and age, bore significant relationships with specified morbidities. For this, those univariate terms where P<0.2 were entered into initial multivariable binary logistic analyses (Hosmer and Lemeshow 2000) and terms were excluded
until a final model of statistical significant terms was achieved.
Results
A total of 96 cases were recorded between 1 August 2013 and 31 July 2014. Of these, 92/96 survived to discharge. Two of the anaesthetics were repeated. The previous data (Senior et al. 2007) reported a total of 194 anaesthetics for nonabdominal procedures of which full data were available for 101 cases. The results are presented in Table 2. Information regarding
age, bodyweight, emergency status, time in hospital and anaesthetic time only pertained to the subset of data provided by M. Senior (101 of 194 anaesthetics) while the prevalence of morbidities relate to the short communication (Senior et al. 2007).
Case background Horses did not differ in age (median 6.0 years in the 2004–5 and 2013–14 groups, P = 0.564). Hospitalisation time was statistically significantly longer in 2013–14 (median of 9 days vs. 6days, P<0.01). Both data sets were incomplete with respect to sex: 2 and 4 horses were missing from the 2013–4 and 2004–5 data sets, respectively. Geldings made up 63% of group 2013–4 compared with 49% of horses from Senior’s dataset from 2004–5(P<0.001). The average anaesthetic
Median age in years (range)*
TABLE 2: Data comparing horses undergoing nonabdominal procedures in 2013–14 and from Senior et al. (2007) Nonabdominal 2013–4 6(0–21)
Median body weight in kg (range)* Median time in hospital in days (range)* Mean anaesthetic time in min (s.d.)* Emergencies (%)*
Post-anaesthetic colic (%) Diarrhoea (%)
Lameness, myopathy, neuropathy (%) Fractures (%)
Wounds in recovery (%) Pyrexia
Thrombophlebitis (%) Wound infection (%) Respiratory distress (%)
* subset of data used from Senior et al. (2007). © 2016 EVJ Ltd
502 (102–836) 9(0–145)
103 (35.8) 29
18.5 (17/92) 1 (1/92) 3 (3/92) 0 0
7.6 (7/92) 2 (2/92) 1 (7/92) 0
Senior et al. 2007 6 (1–25)
500 (252–690) 5 (1–36) 87 (39.5) 21
7.7 2 0 0
0.5 0.5 1
n/a 2
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