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Kovacs JM, Mazdarani P, Nielsen MBM, Miles JE. Objective and owner-reported outcomes after modified cranial closing wedge ostectomy: a case series. Vet Res Commun 2024; 48:877-887. [PMID: 37978161 PMCID: PMC10998822 DOI: 10.1007/s11259-023-10261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023]
Abstract
Immediate and longer-term outcomes of a cranial closing wedge ostectomy variant for management of canine cranial cruciate ligament disease were assessed in this single-center retrospective consecutive study. Records and radiographs were retrieved and assessed by three independent observers to evaluate tibial plateau angle, anatomical-mechanical axis angle, tibial tuberosity distalization, and mechanical axis length before and after surgery. Kinetic gait analysis and owner questionnaires were used to assess clinical outcomes. Seventeen stifles from fifteen dogs were evaluated radiographically. Mean error from target tibial plateau angle was 0.4 degrees. Anatomical-mechanical axis angles reduced from mean 2.9 degrees preoperatively to mean - 0.9 degrees postoperatively. Tibial tuberosity distalization was mean 5.0% of mechanical axis length, and mean reduction in mechanical axis length was 0.1%. Increased tibial plateau angles were noted in 8/17 stifles, with a mean of 9.6 degrees at short-term follow-up. Major complications were observed in 9/17 stifles. Long term follow-up (mean 832 days) was obtained with gait analysis in 8/15 dogs and with questionnaire in 11/15. Most dogs (9/11) were weakly to moderately affected by osteoarthritis symptoms. All values for peak vertical force and vertical impulse normalized to body weight exceeded local lower reference limits for normal dogs, indicating acceptable limb use. Satisfactory immediate and long-term clinical outcomes appear to be possible with this technique, but the high incidence of shorter-term complications may caution against the technique or the fixation and management described here.
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Affiliation(s)
- Jenny M Kovacs
- Lunds Djursjukhus Evidensia, Porfyrvägen 6, Lund, 22478, Sweden
| | - Parisa Mazdarani
- College of Veterinary Medicine, University of Florida, 2015 SW 16th Ave, Gainesville, FL, 32608, USA
| | - Michelle B M Nielsen
- Department of Veterinary Clinical Sciences, University Hospital for Companion Animals, University of Copenhagen, Dyrlægevej 16, Frederiksberg C, 1870, Denmark
| | - James E Miles
- Department of Veterinary Clinical Sciences, University Hospital for Companion Animals, University of Copenhagen, Dyrlægevej 16, Frederiksberg C, 1870, Denmark.
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Glenn OJ, Faux I, Pratschke KM, Bowlt Blacklock KL. Evaluation of a client questionnaire at diagnosing surgical site infections in an active surveillance system. Vet Surg 2024; 53:184-193. [PMID: 37597218 DOI: 10.1111/vsu.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To report sensitivity, specificity, predictive values and accuracy of a client questionnaire at diagnosing surgical site infections (SSIs) and describe the impact of active surveillance on SSI detection. STUDY DESIGN Prospective, cohort study. ANIMALS Dogs and cats undergoing soft tissue or orthopedic surgery over a 12-month period at a referral hospital. METHODS Clients were emailed a questionnaire 30 days postoperatively, or 90 days where an implant was used. Three algorithms were developed to diagnose SSIs using one or both of two criteria: (1) presence of any wound healing problems; (2) wound dehiscence or antibiotic prescription, and either purulent discharge or two or more clinical signs (redness, pain, heat, swelling, discharge). Algorithmic diagnoses were compared to gold standard diagnoses made by veterinarians. RESULTS Of 754 surgical procedures, 309 responses were completed with 173 corresponding gold standard diagnoses. The most accurate algorithm determined "SSI" or "No SSI" from 90.2% of responses with 95.5% (92.4-98.6) accuracy, 82.6% (77-88.3) sensitivity, 97.7% (95.5-100) specificity, 86.4% (81.2-91.5) positive predictive value, and 97% (94.5-99.6) negative predictive value. "No SSI" was diagnosed in responses not meeting criterion 1, and "SSI" in responses meeting criteria 1 and 2. "Inconclusive" responses, comprising 9.8% of responses, met criterion 1 but not 2. Overall SSI rate was 62/754 (8.2%) and 12/62 (19.4%) SSIs were detected by active surveillance only. CONCLUSION Use of this client questionnaire accurately diagnosed SSIs; active surveillance increased SSI detection. CLINICAL SIGNIFICANCE Surveillance of SSIs should be active and can be simplified by using a client questionnaire and algorithmic diagnoses, allowing automated distribution, data collection and analysis.
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Affiliation(s)
- Owen J Glenn
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, UK
| | - Ian Faux
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, UK
| | - Kathryn M Pratschke
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, UK
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Sanders BD, McDonald-Lynch M, Kruse MA. Influence of antiseptic lavage during tibial plateau leveling osteotomies on surgical site infection in 1422 dogs. Vet Surg 2024; 53:167-174. [PMID: 37935116 DOI: 10.1111/vsu.14050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To determine the influence of preclosure antiseptic versus saline lavage on surgical site infections (SSI) in dogs following tibial plateau leveling osteotomy (TPLO). STUDY DESIGN A multicenter retrospective study. SAMPLE POPULATION Dogs treated with TPLO (n = 1422) between December 2019 and October 2021. METHODS The medical records of dogs treated with TPLO were reviewed for preclosure antiseptic lavage or saline irrigation. Additional collected data included signalment, unilateral or bilateral TPLO, postoperative administration of antimicrobial medications, antibiotic agent, surgeon, and development of SSI within 90 postoperative days. Eleven factors were analyzed for association with SSI using univariate and multivariate analysis. RESULTS Data were collected from the records of 519 dogs treated with antiseptic lavage and 903 dogs treated with saline lavage during TPLO. Surgical site infections were diagnosed more frequently in dogs that received preclosure antiseptic lavage (77/519, 14.84%) than those with saline irrigation (80/903, 8.86%) (p = .001). Single session bilateral TPLO increased the odds of SSI by 2.5x (p = .004). The odds of SSI increased by 11% (p = .001) for every 5 kg increase in bodyweight. Postoperative administration of antimicrobials decreased the risk of SSI (p = .008). CONCLUSION The preclosure antiseptic lavage tested here did not decrease the incidence of SSI after TPLO. CLINICAL SIGNIFICANCE The results of this study do not provide evidence to support preclosure antiseptic lavage during TPLOs.
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Otero Balda I, Fuertes-Recuero M, Penelo Hidalgo S, Espinel Rupérez J, Lapostolle B, Ayllón-Santiago T, Ortiz-Díez G. A Spanish Survey on the Perioperative Use of Antimicrobials in Small Animals. Animals (Basel) 2023; 13:2475. [PMID: 37570284 PMCID: PMC10417378 DOI: 10.3390/ani13152475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Appropriate use of perioperative antimicrobials can significantly reduce the risk of post-operative infections. However, inappropriate antimicrobial use can result in the creation of multidrug-resistant bacteria, increased costs, host flora disruption, side effects and increased risk of hospital-acquired infections. This survey evaluated the current perioperative use of antimicrobials in small animals by Spanish veterinarians using a web-based questionnaire. Responses were represented using descriptive statistics and a statistical analysis of the association between demographic data and perioperative antimicrobial use was performed. Pre-operative antimicrobials were administered in clean surgery by up to 68.3% of participants, 81.0% in clean-contaminated surgery and 71.3% in dirty surgery, while in the post-operative period, antimicrobials were administered by up to 86.3% of participants in clean surgery, 93.2% in clean-contaminated surgery and 87.5% in dirty surgery. Factors considered "very important" for antimicrobial selection were the degree of wound contamination, patient immunosuppression and use of prosthesis. The most frequently used antimicrobial was beta-lactamase-resistant (or potentiated) penicillin. Post-operative antimicrobial use was associated with participants without specific surgical postgraduate training. This study highlights an overuse of antimicrobials in perioperative procedures in small animal surgery in Spain. Therefore, evidence-based guidelines and further education regarding the correct use of antimicrobial prophylaxis are recommended.
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Affiliation(s)
- Ignacio Otero Balda
- Department of Small Animal Surgery, Section of Small Animal Clinical Studies, University College Dublin, D04 W6F6 Dublin, Ireland;
| | - Manuel Fuertes-Recuero
- Department of Physiology, College of Veterinary Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Silvia Penelo Hidalgo
- Hospitalization, Emergencies and Critical Care Service, Veterinary Teaching Hospital, Complutense University of Madrid, 28040 Madrid, Spain;
| | | | - Benoit Lapostolle
- Veterinary Teaching Hospital, College of Veterinary Medicine, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - Tania Ayllón-Santiago
- Veterinary Teaching Hospital, College of Veterinary Medicine, Alfonso X el Sabio University, 28691 Madrid, Spain;
- Department of Genetics, Physiology and Microbiology, Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain
| | - Gustavo Ortiz-Díez
- Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
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Aryazand Y, Buote NJ, Hsieh Y, Hayashi K, Rosselli D. Multifactorial assessment of leukocyte reduced platelet rich plasma injection in dogs undergoing tibial plateau leveling osteotomy: A retrospective study. PLoS One 2023; 18:e0287922. [PMID: 37390083 PMCID: PMC10313002 DOI: 10.1371/journal.pone.0287922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
This study assessed the effects of concurrent intra-articular injection and Tibial Plateau Leveling Osteotomy (TPLO) plate surface treatment with leukoreduced platelet rich plasma (lPRP) on outcomes of dogs undergoing TPLO. A retrospective study of medical records for cases presenting from January 2018 to December 2020 was performed. Client-owned dogs with naturally occurring cranial cruciate ligament rupture that underwent TPLO surgery were divided into two groups. The lPRP group included cases that underwent intra-articular injection and plate surface treatment at the time of their TPLO. The control group (C) underwent TPLO without PRP treatment. Data analyzed included: presence of surgical site infection, implant removal rate, degree of change in OA progression score, lameness score progression and radiographic bone healing. The short- and long-term complication rate, hospitalization and antibiotic therapy were also compared between the groups. Descriptive statistics, comparison analyses (Chi square test, t-test, Fisher's exact test) and multi-level logistic regression models were used for statistical analysis. A total of 110 cases met the study inclusion criteria: 54 = lPRP, 56 = C. There were no significant differences between groups with regard to gender, age, presence of meniscal tear, weight, or body condition score. Significant findings included: improved radiographic healing of the osteotomy in the lPRP group, improved global OA scores in the lPRP group, and improved lameness score at recheck examination in the lPRP group. There was no significant difference between the lPRP and C group with regard to surgical site infection and implant removal rate. Concurrent intra-articular injection and plate surface treatment with leukocyte reduced PRP at the time of TPLO, is beneficial in slowing the progression of OA, hastening the radiographic evidence of osteotomy healing, and improved lameness score on recheck examination. Leukocyte reduced PRP was not a significant factor in reducing SSI or implant removal rate.
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Affiliation(s)
- Yazdan Aryazand
- VCA West Los Angeles, Los Angeles, California, United States of America
| | - Nicole J. Buote
- Department of Clinical Sciences, Small Animal Surgery Section, Cornell University College of Veterinary Medicine, Ithaca, New York, United States of America
| | - YuHung Hsieh
- VCA West Los Angeles, Los Angeles, California, United States of America
| | - Kei Hayashi
- Department of Clinical Sciences, Small Animal Surgery Section, Cornell University College of Veterinary Medicine, Ithaca, New York, United States of America
| | - Desiree Rosselli
- VCA West Los Angeles, Los Angeles, California, United States of America
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Wemmers AC, Charalambous M, Harms O, Volk HA. 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. Front Vet Sci 2022; 9:1004637. [PMID: 36532339 PMCID: PMC9748159 DOI: 10.3389/fvets.2022.1004637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/11/2022] [Indexed: 12/17/2023] Open
Abstract
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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Affiliation(s)
- Annika Christina Wemmers
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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Pagès G, Hammer M, Grand JG, Irubetagoyena I. Long-term outcome of tibial plateau leveling osteotomy using an antimicrobial silver-based coated plate in dogs. PLoS One 2022; 17:e0272555. [PMID: 35960740 PMCID: PMC9374240 DOI: 10.1371/journal.pone.0272555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives To evaluate long-term outcome using the BioMedtrix™ TPLO Curve® plate in dogs with cranial cruciate ligament disease (CrCLd) treated by tibial plateau leveling osteotomy (TPLO). Study design Retrospective case study. Animals Dogs (n = 323, 337 stifles). Methods Medical records were searched for dogs presented with CrCLd and treated by TPLO with the BioMedtrix™ TPLO Curve® plate for 3.5 mm screws between March 2018 and December 2020. Tibial plateau angles (TPA) were measured on preoperative, postoperative, and follow-up radiographs. Changes in TPA between postoperative and follow-up radiographs (ModTPA) were calculated. Radiographic bone healing was scored. Complications were evaluated. Surgical site infections (SSI) were compared to a control group of dogs treated with the Synthes™ TPLO plate between January and December 2017. Owners of both groups were contacted by telephone at least 1 year postoperatively. Results The BioMedtrix™ group was composed of 237 dogs (248 stifles), the control group was composed of 86 dogs (89 stifles). In the BioMedtrix™ group, radiographic follow-up was performed at a median of 48 days. Average ModTPA was 1.2°. Bone healing was graded as complete, good, poor, and none in 18%, 62%, 20%, and 0%, respectively. At a median of 786 days postoperatively, minor and major postoperative complications were observed in 6 (2.4%) and 32 (12.9%) cases in this group, respectively. During the first year following the surgery, 23 (9.3%) and 12 (13.5%) cases suffered a SSI, of which 12 (4.8%) and 7 (7.9%) had their implant explanted in the BioMedtrix™ group and the control group, respectively. There was no significant difference between groups for SSI and implant explantations (p = 0.31 and p = 0.29, respectively). Conclusion The BioMedtrix™ TPLO Curve® plate provided a reliable fixation system for osteotomy healing after TPLO. Bone healing and long-term complication rates were similar to previous studies using other implants. SSI rates were similar between the BioMedtrix™ group and the control group. The antimicrobial HyProtect® coating of the plate did not reduce SSI in this study. Clinical significance The BioMedtrix™ TPLO Curve® plate can be safely used for TPLO. The value of the antimicrobial HyProtect® coating of the plate may be questioned, as SSI rate was not lower in this study compared to the control group or previous reports.
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Affiliation(s)
- Geoffrey Pagès
- Surgery Department, Centre Hospitalier Vétérinaire Aquivet, Eysines, France
- * E-mail:
| | - Meike Hammer
- Surgery Department, Centre Hospitalier Vétérinaire Aquivet, Eysines, France
| | | | - Iban Irubetagoyena
- Surgery Department, Centre Hospitalier Vétérinaire Aquivet, Eysines, France
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Cieciora LC, Harms O, Freise F, Seifert H, Fehr M. Ex Vivo Evaluation of the Cranial Tibial Artery and Its Compression through Fragment Rotation during Tibia Plateau Levelling Osteotomy: An Angiographic Three-Dimensional Reconstruction. Vet Comp Orthop Traumatol 2022; 35:220-229. [PMID: 35580615 DOI: 10.1055/s-0042-1745847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To illustrate the arterial vascularity of the proximal tibia three-dimensionally and to evaluate the impact of fragment rotation on the cranial tibial artery by tibia plateau levelling osteotomy (TPLO). METHOD Radiographic angiography and computed tomography (CT) were performed on 12 pelvic limbs from six large-breed canine cadavers before and after TPLO. Three-dimensional (3D) models of the stifle, including osseous and vascular structures, were obtained, and the integrity of the cranial tibial artery was assessed. Post-TPLO CT images were used to analyze compression of the cranial tibial artery by the rotated fragment. RESULTS The uncompressed cranial tibial artery caliber, measured proximally and distally to the osteotomy, was 9.52 mm2 (6.07-18.90 mm2). In all adequately rotated fragments, the mean caliber of the artery on the level of the osteotomy was 1.57 mm2 (0.89-2.93 mm2) after TPLO. This represented a significant decrease of approximately 81%. Only slight cross-sectional area decrease (8.8%) was seen in one limb, which was revealed to have insufficient fragment rotation (2.83 mm). Another limb only showed signs of stretching of the artery (31.51%), which was under-rotated and medially displaced. Pre-TPLO 3D reconstructions were mainly consistent with previous anatomic studies except for the distance between tibial cortex and cranial tibial artery, which appeared closer. CONCLUSION Sufficient fragment rotation leads to compression of the cranial tibial artery. Intraoperative hemorrhage can be caused by laceration of the main cranial tibial artery or by multiple small branches reaching craniolaterally.
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Affiliation(s)
- Lena-Charlott Cieciora
- Department for Orthopaedics and Sports Medicine, Small Animal Clinic, University of Veterinary Medicine Hannover Foundation, Hannover, Germany
| | - Oliver Harms
- Department for Orthopaedics and Sports Medicine, Small Animal Clinic, University of Veterinary Medicine Hannover Foundation, Hannover, Germany
| | - Fritjof Freise
- Institute for Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover Foundation, Hannover, Germany
| | - Hermann Seifert
- Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover Foundation, Hannover, Germany
| | - Michael Fehr
- Clinic for Small Mammals, Reptiles and Birds, University of Veterinary Medicine Hannover Foundation, Hannover, Germany
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Engdahl KS, Boge GS, Bergström AF, Moldal ER, Höglund OV. Risk factors for severe postoperative complications in dogs with cranial cruciate ligament disease - A survival analysis. Prev Vet Med 2021; 191:105350. [PMID: 33892253 DOI: 10.1016/j.prevetmed.2021.105350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyze the effect of surgical technique and other risk factors on severe postoperative complications in dogs with cranial cruciate ligament disease (CCLD). MATERIALS AND METHODS A cohort study of 255 dogs (287 stifles) surgically treated for CCLD at two veterinary university hospitals (2011-2016) was performed. The electronic medical records were reviewed and dog owners and referring veterinarians contacted for additional information. The complications were classified as minor, major and catastrophic, where major and catastrophic were considered severe. A multivariable Cox proportional hazards model was applied to assess risk factors for severe postoperative complications. RESULTS Three surgical techniques were used; lateral fabellotibial suture (LFS, 141 stifles), tibial plateau leveling osteotomy (TPLO, 77 stifles) and tibial tuberosity advancement (TTA, 69 stifles). The most common severe postoperative complications were surgical site infections or complications related to the surgical implant. Severe postoperative complications occurred in 31 % of the stifles treated with TPLO, 22 % of the stifles treated with LFS and 25 % of the stifles treated with TTA. The multivariable Cox proportional hazards model identified surgical technique (p = 0.0258) as a risk factor for severe postoperative complications; TPLO had a significantly lower hazard than LFS (hazard ratio (HR) = 0.37, p = 0.007) when controlling for body weight and age, which also were identified as risk factors (HR = 1.05, p < 0.001 and HR = 0.91, p = 0.047, respectively). CONCLUSION AND CLINICAL RELEVANCE Although TPLO procedures had the highest occurrence of severe postoperative complications, the hazard was lower than for LFS after adjusting for body weight and age. This implies that it is important to consider potential effect-modifiers when comparing postoperative complications after CCLD surgery.
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Affiliation(s)
- Karolina S Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden.
| | - Gudrun S Boge
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences - School of Veterinary Science, P.O. Box 369 Sentrum, N-0102, Oslo, Norway
| | - Annika F Bergström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden
| | - Elena R Moldal
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences - School of Veterinary Science, P.O. Box 369 Sentrum, N-0102, Oslo, Norway
| | - Odd V Höglund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07, Uppsala, Sweden
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McDougall RA, Spector DI, Hart RC, Dycus DL, Erb HN. Timing of and risk factors for deep surgical site infection requiring implant removal following canine tibial plateau leveling osteotomy. Vet Surg 2021; 50:999-1008. [PMID: 33826172 DOI: 10.1111/vsu.13634] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 03/10/2021] [Accepted: 03/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify demographic risk factors for deep surgical site infection (SSI) requiring tibial plateau leveling osteotomy (TPLO) implant removal and time to implant removal. ANIMALS Four hundred and thirty-three dogs that underwent a TPLO (144 that developed a deep SSI and required implant removal, 289 that did not). STUDY DESIGN Retrospective case-control study. METHODS Records of dogs undergoing implant removal due to a deep SSI after TPLO between 2006 and 2018 at two referral centers were reviewed. These records were frequency-matched by date to dogs undergoing TPLO that did not require implant removal. Multivariable analyses tested associations between demographics and implant removal as well as timing of implant removal. RESULTS Deep SSI and implant removal occurred in 144 of 4813 (3.0%; 95% CI: 2.5, 3.5) dogs treated with TPLO. Implant removal was performed at a median of 279 days (range 49-2394 days) postoperatively. Male dogs (OR 1.8; 95% CI: 1.2, 2.7) and German Shepherd dogs (GSDs) (OR 7.4; 95% CI: 2.6, 20.5) were associated with plate removal. Earlier TPLO plate removal was associated with GSDs only (HR 2.4; 95% CI: 1.4, 4.1). CONCLUSION Implant removal due to SSI after TPLO was uncommon, although male dogs and GSDs seemed predisposed to this complication. SIGNIFICANCE These demographic risk factors can be used to educate owners regarding perioperative management.
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Affiliation(s)
- Renee A McDougall
- Department of Surgery, The Animal Medical Center, New York, New York, USA
| | - Daniel I Spector
- Department of Surgery, The Animal Medical Center, New York, New York, USA
| | - Robert C Hart
- Department of Surgery, The Animal Medical Center, New York, New York, USA
| | - David L Dycus
- Department of Surgery, Veterinary Orthopedics and Sports Medicine Group, Annapolis Junction, Maryland, USA
| | - Hollis N Erb
- College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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Budsberg SC, Torres BT, Sandberg GS. Efficacy of postoperative antibiotic use after tibial plateau leveling osteotomy in dogs: A systematic review. Vet Surg 2021; 50:729-739. [PMID: 33709459 DOI: 10.1111/vsu.13603] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A systematic review of published data to determine whether postoperative antibiotic use after tibial plateau leveling osteotomy (TPLO) decreases infection rates. STUDY DESIGN Systematic review. METHODS A broad bibliographic search was performed in three online databases through March 2020 for publications on postoperative antibiotic use after TPLO in dogs. Search terms included dog, canine, TPLO, tibial plateau leveling osteotomy, infection, antibiotic, and antimicrobial. Articles that met inclusion criteria were evaluated for level of evidence (LoE) by a modified Oxford Level of Evidence (mOLE) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) classification and evaluation. RESULTS Thirteen studies met the inclusion criteria. Effect of antibiotic use was the primary question in four studies. Among those, 50% (2/4) were assigned a mOLE of 1b and a GRADE of moderate, while the other 50% (2/4) were assigned a mOLE of 4b or 4c with a GRADE of low. The two studies with the highest LoE did not provide evidence of the benefit of antibiotic usage. Results of only one study provided evidence to support the use of postoperative antibiotics. The remaining nine studies provided evaluation of antibiotic use secondarily and were all assigned a low LoE. Among these, 78% (7/9) provided evidence to support the use of postoperative antibiotics. CONCLUSION We found little evidence to support the use of postoperative antibiotics to reduce the risk of surgical site infections in dogs after TPLO. The answer to this clinical question is complicated by the lack of prospective studies and inconsistent treatment protocols in the evaluated studies. CLINICAL SIGNIFICANCE The clinical impact of postoperative antibiotic administration on infection rates after TPLO is uncertain.
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Affiliation(s)
- Steven C Budsberg
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia.,Department of Comparative Physiology and Pharmacology, University of Georgia, Athens, Georgia
| | - Bryan T Torres
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri
| | - Gabriella S Sandberg
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia
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McCagherty J, Yool DA, Paterson GK, Mitchell SR, Woods S, Marques AI, Hall JL, Mosley JR, Nuttall TJ. Investigation of the in vitro antimicrobial activity of triclosan-coated suture material on bacteria commonly isolated from wounds in dogs. Am J Vet Res 2020; 81:84-90. [PMID: 31887087 DOI: 10.2460/ajvr.81.1.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate in vitro effects of triclosan coating of suture materials on the growth of clinically relevant bacteria isolated from wounds in dogs. SAMPLE 6 types of suture material and 10 isolates each of methicillin-susceptible Staphylococcus pseudintermedius, methicillin-resistant S pseudintermedius, Escherichia coli, and AmpC β-lactamase and extended-spectrum β-lactamase-producing E coli from clinical wound infections. PROCEDURES Isolates were cultured on Mueller-Hinton agar with 3 types of triclosan-coated suture, uncoated counterparts of the same suture types, and positive and negative controls. Zones of inhibition (ZOIs) were measured after overnight incubation. Sustained antimicrobial activity assays were performed with susceptible isolates. The ZOI measurements and durations of sustained antimicrobial activity were compared among suture types and isolates by statistical methods. Suture surface characteristics and bacterial adherence were evaluated qualitatively with scanning electron microscopy. RESULTS ZOIs were generated only by triclosan-coated materials; triclosan-coated suture had sustained antimicrobial activity (inhibition) for 3 to 29 days against all tested pathogens. The ZOIs around triclosan-coated suture were significantly greater for S pseudintermedius isolates than for E coli isolates. Bacterial adherence to uncoated polyglactin-910 was greatest, followed by triclosan-coated polyglactin-910, and then uncoated monofilament sutures, with least adherence to coated monofilament sutures. CONCLUSIONS AND CLINICAL RELEVANCE Surface characteristics of suture materials may be as important or more important than triclosan coating for microbial inhibition; however, triclosan coating appeared to affect bacterial adherence for multifilament sutures. Triclosan-coated, particularly monofilament, sutures inhibited pathogens commonly isolated from wounds of dogs, including multidrug-resistant bacteria. Further studies are required to assess clinical efficacy of triclosan-coated suture materials in vivo.
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Shrestha P, Zhang Y, Chen WJ, Wong TY. Triclosan: antimicrobial mechanisms, antibiotics interactions, clinical applications, and human health. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, TOXICOLOGY AND CARCINOGENESIS 2020; 38:245-268. [PMID: 32955413 DOI: 10.1080/26896583.2020.1809286] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The large-scale applications of Triclosan in industrial and household products have created many health and environmental concerns. Despite the fears of its drug-resistance and other issues, Triclosan is still an effective drug against many infectious organisms. Knowing the cross-interactions of Triclosan with different antibiotics, bacteria, and humans can provide much-needed information for the risk assessment of this drug. We review the current understanding of the antimicrobial mechanisms of Triclosan, how microbes become resistant to Triclosan, and the synergistic and antagonistic effects of Triclosan with different antibiotics. Current literature on the clinical applications of Triclosan and its effect on fetus/child development are also summarized.
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Affiliation(s)
- Prabin Shrestha
- Biological Sciences Department, University of Memphis, Memphis, Tennessee, USA
| | | | - Wen-Jen Chen
- Biological Sciences Department, University of Memphis, Memphis, Tennessee, USA
| | - Tit-Yee Wong
- Biological Sciences Department, University of Memphis, Memphis, Tennessee, USA
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Pantaleon L. Why measuring outcomes is important in health care. J Vet Intern Med 2019; 33:356-362. [PMID: 30784125 PMCID: PMC6430924 DOI: 10.1111/jvim.15458] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/04/2019] [Indexed: 12/04/2022] Open
Abstract
A new strategy has been introduced in human health care, namely, achieving the best outcomes for the lowest cost and thus maximizing value for patients. In value‐based care, the only true measures of quality are the outcomes that matter to patients. When outcomes are measured and reported, it fosters improvement and adoption of best practices, thus further improving outcomes. Understanding outcomes is central in providing value and represents an opportunity for redefining veterinary patient care. Value is created by improving the outcomes of patients with a particular clinical condition over the full cycle of care, which normally involves multiple specialties and care sites. To be successful, a key aspect of value based care is working as teams (integrated practice units) centered around the patient's clinical condition. As veterinary medicine has become more specialized and more complex, multidisciplinary communication and trust among the care team are paramount in providing value to patients (and clients). Use of patient‐reported outcomes is an essential aspect for improving clinical care, because it enhances the connections among doctors and with patients. Designing and implementing owner‐reported outcomes in veterinary clinical practice will lead to an understanding of the effects of treatments on outcomes and quality of life (QOL) of our patients from the owner's perspective, a key way to assess a veterinary patient's QOL.
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