SummaryPostoperative complications and mortality can occur many weeks or months after colic surgery. We are interested in the long-term outcome of these cases. This study documents patterns of mortality and morbidity among 341 horses that recovered from colic surgery March 1998-August 2000. The progress of each horse was rigorously followed by periodic telephone and postal questionnaires. Event time data were recorded for each animal and a total of 321 horse years of survival, together with death from all causes, colic-related death and various postoperative complications.Postoperative survival (of all horses excluding grass sickness cases) was triphasic over the first 600 days and there was marked mortality in the first 10 days postoperatively. The probability of survival postoperatively decreased to 0.87 by 10 days, 0.82 by 100 days and declined slowly to 0.75 at 600 days. Horses suffering from epiploic foramen entrapment had a significantly reduced probability of postoperative survival (RR = 2.1, P = 0.033). The causes of death for 104 horses that died postoperatively and the prevalence of postoperative complications are recorded for the study population. Postoperative colic was the most prevalent complication with 100 horses (29%) suffering one or more episodes. However, only 16 horses (4.6%) suffered 3 or more episodes. The incidence of postoperative colic was 0.55 episodes/horse year at risk. This study provides data that will inform the prognosis for postoperative colic cases and identifies epiploic foramen entrapment as carrying a worse prognosis for survival than other strangulating lesions.

The decision to develop rotavirus vaccines was predicated on the extensive burden of rotavirus disease among children worldwide. US reports on nationwide hospitalizations (1979-1992) and deaths (1968-1991) due to diarrhea and weekly reports of rotavirus infection by 74 laboratories were reviewed to estimate the burden of rotavirus disease, identify epidemiologic trends, and consider methods for evaluating an immunization program when a vaccine becomes available. From 1968 to 1985, diarrhea-related deaths among US children <5 years old declined from 1100 to 300/year. This decline was associated with the disappearance of winter peaks for diarrhea-related deaths previously associated with rotavirus infection among children 4-23 months old. From 1979 to 1992, however, hospitalizations for diarrhea averaged 186,000/year and retained their winter peaks, which have been linked to rotavirus infections. Each year an estimated 54,000-55,000 US children are hospitalized for diarrhea, but <40 die with rotavirus. A rotavirus vaccine program will require improved surveillance, including the timely collection of data from sentinel hospitals, in which a diagnosis of rotavirus can be established or ruled out for all children hospitalized for diarrhea.

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SummaryThe reason for u n d e rtaking this study was that postoperative complications of colic surgery lead to patient discomfort , p rolonged hospitalisation and increased cost. Potential risk factors for the 6 most common postoperative complications ( j u g u l a r t h rombosis, ileus, re -l a p a ro t o m y, wound suppuration, incisional herniation and colic) were evaluated using multivariable models. Jugular t h rombosis was associated significantly with heart rate gre a t e r than 60 beats/min and with i n c reased packed cell volume (PCV) at admission. The risk of postoperative ileus also increased with increasing PCV a t admission and was higher in horses recovering fro m pedunculated lipoma obstruction. Incisional herniation was s t rongly associated with wound suppuration and with i n c reasing heart rate at admission. The emergence of c a r d i o v a s c u l a r parameters as risk factors for s e v e r a l postoperative complications is consistent with the hypothesis that endotoxaemia is important in the development of these complications. Early referral of colic cases, prior to the development of severe endotoxaemic shock, may minimise the risk of some postoperative complications. Horses that have s u ff e red epiploic foramen entrapment, are more than 4 times as likely to undergo re -l a p a rotomy than other horses. Horses that have suff e red postoperative ileus have a similarly increased risk of undergoing re -l a p a ro t o m y. The risk of postoperative colic is significantly associated with horses recovering from large colon torsion (>360°) and with having undergone re -l a p a ro t o m y. Hazard ratios (with 95% confidence intervals) for these last two e ffects are 3.1 (1.7, 5.7) and 3.4 (1.9, 6.2), re s p e c t i v e l y. Knowledge of the risk factors for postoperative complications allows more accurate prognostication postoperatively and suggests ways in which the risk of postoperative complications can be minimised.