Risk factors for severe postoperative complications in dogs with cranial cruciate ligament disease – A survival analysis

Engdahl, Karolina; Boge, Gudrun Seeberg; Bergström, Annika; Moldal, Elena Regine; Höglund, Odd Viking

doi:10.1016/j.prevetmed.2021.105350

Cited by 4 publications

(9 citation statements)

References 41 publications

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“…However, if one takes a closer look at the type of complication as well as the size of the dog, differences nevertheless may become apparent. Both techniques showed higher complication rates in medium and large breed dogs, which confirmed recent findings that weight is associated with a higher risk for complications ( 27 , 28 , 71 ). Due to a lack of prospective, controlled, randomized and blinded studies, we were not able to perform a complete meta-analysis on outcome parameters.…”

Section: Discussionsupporting

confidence: 88%

“…In several studies, other potential sources of bias have been identified ( Table 1 ). Many studies were of retrospective nature ( 42 , 50 , 52 , 53 , 55 , 56 , 58 – 61 , 63 , 64 , 71 – 95 ) which imposes a high risk of bias as protocols have not been standardized beforehand. Also, reported outcomes which might be different from the true outcome as potential follow-up losses cannot be identified.…”

Section: Resultsmentioning

confidence: 99%

“…Also, reported outcomes which might be different from the true outcome as potential follow-up losses cannot be identified. Studies with unclear financial support ( 62 , 63 , 83 , 87 , 96 , 97 ), support of financial nature, consultant activity, company collaboration or speaker engagement ( 31 – 33 , 36 – 38 , 40 , 44 , 46 , 47 , 56 , 60 , 65 , 69 , 71 , 72 , 76 , 98 ) (e.g., financial funding) or other potential conflicts of interests ( 39 , 50 , 51 , 54 , 57 , 59 , 67 , 73 , 80 , 92 ) led to an unclear risk of bias.…”

Section: Resultsmentioning

confidence: 99%

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Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement–A systematic review with a meta-analytic approach

et al. 2022

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Tibial Plateau Leveling Osteotomy (TPLO) or Tibial Tuberosity Advancement (TTA) are commonly used surgical techniques for correction of cranial cruciate ligament (CCL) rupture in dogs. This systematic review aims to investigate whether one technique is superior to the other. Seventy-two studies on surgical management of CCL rupture have been identified and evaluated in regard of subjective and objective gait analysis criteria, development of osteoarthritis (OA), thigh circumference measurements, goniometry, joint stability, pain and complication rates. Almost half (47.2 %) of the studies were considered of low quality of evidence, leading to high heterogeneity in quality among studies; this posed a major limitation for an evidence-based systematic review of both surgical techniques. Out of 72 studies, there were only eleven blinded randomized clinical trials, of which five were rated with a low overall risk of bias. However, both techniques were considered to be successful management options. Subjective and objective gait analysis revealed no lameness at long-term evaluation for the majority of the patients. However, it appeared that TTA lead to better OA scores up to 6 months postoperatively, while TPLO had a lower rate of surgical site infections. In summary, no method can be clearly preferred, as most of the study evaluated were subpar. Studies with a high level of evidence are therefore urgently needed for such a common surgical procedure.

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Section: Discussionsupporting

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement–A systematic review with a meta-analytic approach

et al. 2022

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“…The aim of this study was to investigate the outcomes of different extracapsular repair techniques performed by GP veterinarians. Although multiple retrospective studies have reported the complication rates of extracapsular repair patients in a referral environment (Vasseur 1984, Lazar et al 2005, Cook et al 2010a,b, Nelson et al 2013, Ritzo et al 2014, Krotscheck et al 2016, Cox et al 2020, Engdahl et al 2021, based on our literature search, no prior study has evaluated outcome of these techniques when performed by veterinarians with no advanced surgical training. This is important information, as most extracapsular repairs are performed in the GP setting, especially in large dogs where TO techniques are more commonly performed by referral surgeons (Duerr et al 2014, von Pfeil et al 2018.…”

Section: Discussionmentioning

confidence: 98%

“…2020, Engdahl et al . 2021), based on our literature search, no prior study has evaluated outcome of these techniques when performed by veterinarians with no advanced surgical training. This is important information, as most extracapsular repairs are performed in the GP setting, especially in large dogs where TO techniques are more commonly performed by referral surgeons (Duerr et al .…”

Section: Discussionmentioning

confidence: 99%

Complications and postoperative non‐steroidal anti‐inflammatory use of three extracapsular cruciate ligament repair techniques performed in a general practice clinic environment

Franklin

House

Pfeiffer

2022

J of Small Animal Practice

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Objective To report complications and postoperative non‐steroidal anti‐inflammatory use associated with fabellotibial suture, Tightrope and Ligafiba Isotoggle procedures performed on dogs of varying weights within a general practice setting. Materials and Methods Clinical records of eligible patients from 2009 to 2018 were retrospectively extracted from five general practice clinics. Data for signalment, patient weight, surgery performed, complications, postoperative use of non‐steroidal anti‐inflammatory drugs, and timing thereof were extracted and analysed using multinomial logistic regression. Predicted probability tables were generated for complications and non‐steroidal anti‐inflammatory drug use. Results The study included 370 surgeries, with 97 fabellotibial suture, 158 Tightrope and 42 Ligafiba Isotoggle procedures in patients less than 15 kg, and 43 fabellotibial suture, 16 Tightrope and 30 Ligafiba Isotoggle procedures in patients at least 15 kg. The proportion of patients that can be expected to have no complications was greatest for older dogs (9 years) weighing less than 15 kg (fabellotibial suture, 91%; Tightrope/Ligafiba Isotoggle, 88%), and the highest major medical and surgical complication risks were expected in young dogs (1 year) weighing over 15 kg (fabellotibial suture, 28%; Tightrope/Ligafiba Isotoggle, 59%). The predicted risk of requiring repeated non‐steroidal anti‐inflammatory drug prescriptions in the 18‐month postoperative period for an 15 kg patient was 37% to 39%. Conclusion Weight and age were significant factors influencing complications and postoperative non‐steroidal anti‐inflammatory drug use in fabellotibial suture, Tightrope and Ligafiba Isotoggle surgical patients in a general practice setting. Clinical Significance Clinicians should consider the possibility of complications and requirement for ongoing non‐steroidal anti‐inflammatory drug use before performing extracapsular procedures in patients weighing more than 15 kg.

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Economic Considerations on Costs and Pricing of Two Surgical Techniques for Treating Cranial Cruciate Disease in Dogs

Wemmers¹,

Pawlak²,

Medl³

et al. 2023

Animals

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In surgical treatment of cranial cruciate ligament disease in dogs, Tibial Plateau Levelling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) are commonly established procedures and have proven effective in restoring limb function. Unlike clinical outcome, economic aspects have not been studied as extensively. However, the surgical intervention poses an enormous financial burden on patients’ owners. In a veterinary practice setting, this study compares prices for TPLO and TTA and examines prices differences as well as potential cost drivers. Charges for veterinary treatments are based on the Gebührenordnung für Tierärztinnen und Tierärzte (GOT), which is mandatory for veterinarians in Germany but allows a certain range in billing. This study found that TPLO is charged at a higher price than TTA; however, this might not cover the additional costs of this procedure. The price is also associated with weight, heavier dogs being more expensive. The underlying strategies for pricing decisions may be based on costs, as efforts for TPLO and heavier dogs are higher in terms of a prolonged surgical time, the number of staff involved and in surgeons’ training. Price setting may also be based on a quality promise, suggesting better clinical outcome in a more expensive procedure. Future investigations should involve economic considerations and consider cost-effectiveness analysis when evaluating surgical treatment options.

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Risk factors for severe postoperative complications in dogs with cranial cruciate ligament disease – A survival analysis

Cited by 4 publications

References 41 publications

Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement–A systematic review with a meta-analytic approach

Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement–A systematic review with a meta-analytic approach

Complications and postoperative non‐steroidal anti‐inflammatory use of three extracapsular cruciate ligament repair techniques performed in a general practice clinic environment

Economic Considerations on Costs and Pricing of Two Surgical Techniques for Treating Cranial Cruciate Disease in Dogs

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