Impact of postoperative antibiotics on rates of infection and implant removal after tibial tuberosity advancement in 1,768 canine stifles

Antimicrobial prophylaxis in companion animal surgery: A scoping review for European Network for Optimization of Antimicrobial Therapy (ENOVAT) guidelines

Surgical antimicrobial prophylaxis (SAP) is widely used to reduce the risk of surgical site infections (SSI), but there is uncertainty as to what the proportion of SSI reduction is. Therefore, it is difficult for surgeons to properly weigh the costs, risks and benefits for individual patients when deciding on the use of SAP, making it challenging to promote antimicrobial stewardship in primary practice settings. The objective of this study was to map the veterinary evidence focused on assessing the effect of SAP on SSI development and in order to identify surgical procedures with some research evidence and possible knowledge gaps. In October 2021 and December 2022, Scopus, CAB Abstracts, Web of Science Core Collection, Embase and MEDLINE were systematically searched. Double blinded screening of records was performed to identify studies in companion animals that reported on the use of SAP and SSI rates. Comparative data were available from 34 out of 39123 records screened including: eight randomised controlled trials (RCT), 23 cohort studies (seven prospective and 16 retrospective) and three retrospective case series representing 12476 dogs and cats in total. Extracted data described peri- or post-operative SAP in nine, and 25 studies, respectively. In the eight RCTs evaluating SAP in companion animals, surgical procedure coverage was skewed towards orthopaedic stifle surgeries in referral settings and there was large variation in SAP protocols, SSI definitions and follow-up periods. More standardized data collection and agreement of SSI definitions is needed to build stronger evidence for optimized patient care.

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

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.

Factors Contributing to the Need for Non-Elective Explant following Surgical Repair of Tibial Tuberosity Avulsion Fracture

OBJECTIVE

 The aim of this study was to evaluate factors contributing to the need for non-elective explant following surgical repair of tibial tuberosity avulsion fractures.

STUDY DESIGN

 Retrospective multicentre case-control study. Over a 5-year period, dogs (n = 63) that underwent surgical repair of tibial tuberosity avulsion fractures (n = 64) were considered. Dogs that underwent a non-elective explant were compared with those that did not. Continuous variables were compared with the Mann-Whitney U test. Categorical variables were compared with the Fisher's exact test. Variables which were significant on univariate analysis were entered into a multiple logistic regression model. Significance was set at p < 0.05.

RESULTS

 Non-elective explant was performed in 20/64 fractures and elective explant was performed in 2/64 fractures. Neutered dogs were found to be 19 times (95% confidence interval: 2.1-172) more likely to require explant compared with intact dogs (p = 0.009). Every 0.25 mm increase in average pin size was found to make it 2.5 times (95% confidence interval: 1.3-4.9) more likely to require explant (p = 0.006).

CONCLUSION

 The findings suggest that use of the smallest appropriate pin should be considered for standard surgical repair of tibial tuberosity avulsion fractures to minimize the risk of requiring non-elective explant.