Use of perioperative variables to determine the requirement for repeat celiotomy in horses with postoperative reflux after small intestinal surgery

Abstract

Objective To determine whether perioperative variables can be used to differentiate a medical vs a surgical reason for postoperative reflux (POR) after small intestinal (SI) surgery in horses. Study design Retrospective study. Sample population Horses >1 year of age that recovered from SI surgery and had POR. Methods Medical records of horses that underwent SI surgery and developed POR from 2009‐2015 were reviewed. Surgical reasons for POR were defined as an anastomosis complication, mechanical obstruction, or nonviable intestine identified at repeat celiotomy/necropsy. A medical reason for POR was presumed when the POR improved with medical treatment or when no surgical reasons were identified at repeat celiotomy/necropsy. Perioperative variables were analyzed and used to develop a logistic regression model. Results Fifty‐one horses had POR after SI surgery. After initial SI surgery, 14 horses had surgical reasons for POR diagnosed at repeat celiotomy or necropsy. Thirty‐seven horses were considered to have medical reasons for POR because their POR resolved with medical management or functional ileus was diagnosed at repeat celiotomy/necropsy. A greater volume and a greater duration of POR were not associated with a surgical reason for POR. Rather, a postoperative (PO) fever and the timing of colic in the PO period were associated with a surgical reason for POR. Conclusion Horses that developed a fever and colic in the PO period after SI surgery were more likely to have a surgical reason for POR. Clinical significance These findings may provide guidance for clinicians when they are making decisions about repeat celiotomy in horses with POR after SI surgery.

Prevalence of and risk factors associated withSalmonellashedding among equids presented to a veterinary teaching hospital for colic (2013–2018)

“…Freeman et al 16 found that a higher rectal temperature (>39.1°C) postoperatively after colic surgery was associated with an increased risk of Salmonella shedding. Another recent study 17 looking at horses with POR after small intestinal surgery found that horses that developed a fever or colic signs in the postoperative period were more likely to have a surgical reason for having POR. However, as part of that study horses positive for Salmonella were excluded.…”

Mortality and morbidity in equine anaesthesia

“…Post-anaesthetic ileus (POI) is a specific cause of PAC and is described in 6-40% of horses after abdominal surgery with varying mortality from 14 up to 66% (Mee et al 1998b;Freeman et al 2000;Morton and Blikslager 2002;Proudman et al 2002;Cohen et al 2004;Mair and Smith 2005a,b;Holcombe et al 2009;Torfs et al 2009Torfs et al , 2015Jacobs et al 2019). The diagnosis is based on small intestinal dysmotility and/or distension with reflux of large volumes of intestinal content, tachycardia, abdominal discomfort, reduced faecal output or absent borborygmy (Lefebvre et al 2016).…”