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

Repeat Celiotomy-Current Status

Repeat celiotomy can be lifesaving in horses with a surgically treatable postoperative obstruction, although guidelines for its use are lacking, except for uncontrollable postoperative pain. Overdiagnosis of ileus as the cause of postoperative obstruction could delay a second surgery so the disease progresses beyond a manageable level of severity. Although many horses respond favorably to repeat celiotomy, complications can be severe and life threatening, such as incisional infection and adhesions. Repeat celiotomy does not seem to exacerbate postoperative ileus, despite additional surgical manipulation. An important benefit of repeat celiotomy is termination of hopeless cases, thereby reducing cost and suffering.

Prevalence of and risk factors associated with Salmonella shedding among equids presented to a veterinary teaching hospital for colic (2013-2018)

BACKGROUND

Gastrointestinal disease has been associated with shedding of Salmonella with previous studies demonstrating that horses with colic have a higher risk of acquiring and shedding Salmonella organisms.

OBJECTIVES

The purpose of this study was to determine the prevalence of and risk factors associated with Salmonella shedding in a colic population at a referral clinic.

STUDY DESIGN

Retrospective case-control study.

METHODS

For each colic case that was positive for Salmonella (n=56), two colic cases (n=112) that tested negative for Salmonella, were enrolled as controls. Associations between variables and Salmonella shedding were identified using logistic regression. Univariate and multivariable models were developed pertaining to 1) presenting clinicopathological data and 2) clinical variables that developed during hospitalisation.

RESULTS

Of the equids presenting with colic, 1585/1917 had a sample submitted for Salmonella testing. Of these, 56 were positive for Salmonella yielding a prevalence of 3.5%. Equids shedding Salmonella were more likely to present in July (OR=7.2, 95% CI=1.63-32.13, p=0.009) and present with a history of fever (OR=53.5; 95% CI=2.57-1113.03; p=0.01), increased lactate (OR=1.6; 95% CI=1.14-2.29; p=0.007) and/or neutropenia (OR=0.79; 95% CI=0.65-0.97; p=0.02). Hospitalised equids shedding Salmonella were more likely to be febrile (OR=4.8; 95% CI=1.47-15.8; p=0.01) and 10 times more likely to develop reflux (OR=10.1; 95% CI=1.67-61.43; p=0.01) compared to colic controls.

MAIN LIMITATIONS

Retrospective nature of the study and bias inherent to the retrieval of data from medicals records cannot be discounted. Classifying Salmonella status based on a single sample may have resulted in misclassification bias.

CONCLUSIONS

The prevalence of Salmonella shedding in this colic population was low compared to earlier reports. Certain predictors such as the development of a fever or reflux in hospitalised colic cases were associated with Salmonella shedding and may help the clinician to promptly identify horses likely to shed, thus helping institute effective use of barrier nursing precautions.