Comparison of complication rates following elective arthroscopy performed as inpatient versus outpatient surgery in horses

Abstract

OBJECTIVE To report complication rates following elective arthroscopy in horses and determine whether postoperative complication rates are higher for outpatient procedures, compared with inpatient procedures. DESIGN Retrospective cohort study. ANIMALS 357 client-owned horses that had undergone 366 elective arthroscopic procedures between January 2008 and February 2015. PROCEDURES Medical records were retrospectively reviewed. Data collected included signalment, travel time to the hospital, clinical signs, joints treated, lesions diagnosed, medications administered, anesthesia and surgery times, details of the procedure (including closure method and surgeons involved), and hospitalization status (inpatient or outpatient). Inpatients were horses that remained hospitalized overnight, and outpatients were horses that were discharged in the afternoon of the day of surgery. The collected data were analyzed along with follow-up information to identify factors associated with postoperative complications and potentially associated with hospitalization status. RESULTS Data were collected on 366 elective arthroscopic procedures (outpatient, n = 168 [46%]; inpatient, 198 [54%]). Complications that occurred included bandage sores, catheter problems, colic, diarrhea, postoperative discomfort, esophageal impaction, fever, incisional drainage, postanesthetic myopathy, persistent synovitis, persistent lameness, septic arthritis, and osteochondral fragments not removed during the original surgery. None of these complications were associated with hospitalization status (outpatient vs inpatient). However, Standardbreds were overrepresented in the outpatient group, and anesthesia and surgery times were longer for the inpatient group. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that outpatient elective arthroscopy in healthy horses could be performed safely and without a higher risk of complications, com pared with similar procedures performed on an inpatient basis.

Antimicrobial prophylaxis is not indicated for horses undergoing general anaesthesia for elective orthopaedic MRI

“…In the absence of surgical trauma, it would be reasonable to expect the incidence of fever following recovery from anaesthesia to be minimised 31 . However, the incidence of post‐anaesthetic fever of 5.6% in our study was similar to previous studies in healthy horses undergoing minimally invasive arthroscopic surgery which have shown the incidence of fever to be approximately 2%–5.1% 18,32 . A study by Borg and Carmalt 18 showed that 9 of 444 (2%) horses undergoing elective arthroscopy developed a post‐operative fever.…”

“…Of these nine horses, one developed pneumonia (1/444, 0.02%), two had signs of a mild upper airway infection (2/444, 0.04%) and one horse developed a transient colic that responded to medical treatment. 18 Similarly, a study by Secor et al 32 showed 14 of 273 (5%) horses undergoing arthroscopic surgery developed fever which was typically noted within the first 24 h after surgery. Of the horses that developed a fever after surgery, two also developed diarrhoea that required additional treatment and another had a haematoma at the iv catheter site.…”

“…Of the horses that developed a fever after surgery, two also developed diarrhoea that required additional treatment and another had a haematoma at the iv catheter site. The rest of the fevers were resolved without further intervention 32 …”

“…31 However, the incidence of postanaesthetic fever of 5.6% in our study was similar to previous studies in healthy horses undergoing minimally invasive arthroscopic surgery which have shown the incidence of fever to be approximately 2%-5.1%. 18,32 A study by Borg and Carmalt 18 showed that 9 of 444 (2%) horses undergoing elective arthroscopy developed a post-operative fever. Of these nine horses, one developed pneumonia (1/444, 0.02%), two had signs of a mild upper airway infection (2/444, 0.04%) and one horse developed a transient colic that responded to medical treatment.…”

“…The rest of the fevers were resolved without further intervention. 32 In people, the most common causes of post-surgical fevers are allergic reactions to drugs, urinary tract infections, respiratory infections, surgical site infections and phlebitis. 33 Unlike people, allergic reactions to medications and urinary tract infections secondary to urinary catheterisation are not well-documented in equid cases, leaving respiratory infections, thrombophlebitis and gastrointestinal disturbance as the most likely source of distant site infection in our population of cases.…”