Study of the clinical effects of postoperative parenteral nutrition in 15 horses

Equine nutrition in the post-operative colic: Survey of Diplomates of the American Colleges of Veterinary Internal Medicine and Veterinary Surgeons, and European Colleges of Equine Internal Medicine and Veterinary Surgeons

Background

Evidence is lacking concerning re‐introduction of feed and water following colic surgery.

Objectives

To describe current approaches of European and American specialists to re‐introduction of feed and water in adult horses following surgical treatment of common intestinal lesions, assuming an uncomplicated recovery.

Study design

Cross‐sectional survey.

Methods

Electronic invitations, with a link to the online survey, were sent to 1,430 large animal specialists, including Diplomates of the ECVS, ACVS, ECEIM and ACVIM colleges.

Results

The response rate was 12.6% including partial respondent data. Responses for each multiple‐choice question were between 123 and 178. Results are expressed as the percentage of the total number of responses and as a range where specific lesions are grouped together. Respondents reported that horses with large intestinal displacements were offered free choice water (63%‐65%) within 3 hours (55%‐63%), whereas horses with a small intestinal strangulating lesion were offered < 2 L water (64%‐74%) 12‐24 hours (28%‐34%) post‐operatively. Horses with a large colon displacement were offered feed within 3 hours of surgery (16%) with the majority offered feed 6‐12 hours (35%‐36%) post‐operatively. Horses with small intestinal strangulating lesions and small colon lesions were offered feed 24‐48 hours (34%‐42%) after surgery. Following small intestinal, small colon or caecal lesions, horses were re‐introduced feed in handfuls (79%‐93%) and initially with grass (41%‐54%). Horses with large colon displacements were mostly fed handfuls (49%‐50%) of forage initially, but a number of respondents would offer larger quantities such as a small bucket (35%‐37%) and predominantly of hay (50%‐51%).

Main limitations

Low response rate. This study did not take into account common post‐operative complications that may alter the clinical approach.

Conclusions

This post‐operative colic nutrition survey is the first to describe current clinical practice. Further research is required to investigate nutritional strategies in post‐operative colic cases.

RETROSPECTIVE EVALUATION OF THE USE OF PARENTERAL NUTRITION IN HOSPITALIZED NONDOMESTIC RUMINANTS

Parenteral nutrition (PN) is one method of providing nutrient support to hospitalized, nondomestic ruminants that have a decreased appetite in hospital or have high metabolic demands caused by illness. There are a limited number of published reports of the use of PN in nondomestic ruminants. A retrospective evaluation of PN use in adult (>6 mo of age) hospitalized ruminants at the San Diego Zoo Safari Park was conducted from 2014 to 2018 (n = 24). Discharge rate for animals that received PN was 34%. Poor survival was likely caused by case selection of animals that had severe disease or malnutrition necessitating the need for PN. Common metabolic changes among the study animals included the following: hypokalemia, hyperglycemia, and hyperphosphatemia or hypophosphatemia. Bivariable analysis revealed no clinically significant factors that influenced odds of survival. There was little evidence of adverse effects with the administration of PN during the study period. Parenteral nutrition requires specialized equipment and technical skills, but is a viable means of nutrient support for hospitalized nondomestic ruminants.

Enteral/Parenteral Nutrition in Foals and Adult Horses Practical Guidelines for the Practitioner

Nutritional support is an important adjunct to medical therapy in the sick, injured, or debilitated equine patient. What is not clear is the optimal route, composition, or amounts of support. The enteral route should be chosen whenever possible to maximize the benefits to the gastrointestinal tract and the patient as a whole. Complete or partial parenteral nutrition is most useful as a bridge during recovery and transition to enteral feeding in the horse. The reader is encouraged to consider nutritional support whether enteral or parenteral in any anorexic, chronically debilitated, or sick equine patient.

Prevention of post operative complications following surgical treatment of equine colic: Current evidence

Changes in management of the surgical colic patient over the last 30 years have resulted in considerable improvement in post operative survival rates. However, post operative complications remain common and these impact negatively on horse welfare, probability of survival, return to previous use and the costs of treatment. Multiple studies have investigated risk factors for post operative complications following surgical management of colic and interventions that might be effective in reducing the likelihood of these occurring. The findings from these studies are frequently contradictory and the evidence for many interventions is lacking or inconclusive. This review discusses the current available evidence and identifies areas where further studies are necessary and factors that should be taken into consideration in study design.

Assessment of quality of life in equine patients

REASONS FOR PERFORMING STUDY

Assessing patients' quality of life (QOL) is a core part of clinical decision making. Various methodologies for assessing patients' QOL have been developed in human medicine and small animal veterinary disciplines. In contrast, the lack of aids for QOL assessment in equine veterinary practice leaves practitioners reliant on subjective assessments of QOL, which may be prone to avoidable errors.

OBJECTIVES

This paper suggests pragmatic ways in which QOL may be enhanced, while remaining appropriate for the time, financial and owner-based constraints within equine practice.

METHODS

Through interdisciplinary research, this paper identifies, adapts and applies insights from several areas of research and practical experience in order to develop an overarching approach to making QOL-based decisions in clinical cases.

RESULTS

The paper identifies 6 steps involved in QOL-based decision making and provides examples of how these steps may be practically applied. These include deciding what each clinician feels is important; deciding how to evaluate it, including taking owners' views into consideration; making decisions about each case and achieving the desired clinical outcomes.

CONCLUSIONS

Practitioners can draw their own conclusions on how they may improve QOL assessment in practice and may usefully share these with colleagues. Reporting cases and sharing practical examples of QOL tools used on the ground are vital to the development of this field and appropriate methodologies.

POTENTIAL RELEVANCE

Improvements in QOL assessment are relevant to all areas of equine veterinary practice, and several areas of research. Further research may develop QOL assessment in practice, but more important are the personal improvements that each practitioner may achieve.

Nutritional and clinicopathological effects of post operative parenteral nutrition following small intestinal resection and anastomosis in the mature horse

REASONS FOR PERFORMING STUDY

There is an absence of data describing the nutritional requirements and nutritional status of horses following surgery for colic; furthermore, the potential effect of parenteral nutrition (PN) on improving nutritional status in such cases is unknown.

HYPOTHESIS

Post operative colic cases suffer from a potentially detrimental negative energy balance and the PN formulation developed in this study would lead to clinicopathologically detectable improvements in the subjects' nutritional status.

METHODS

Several clinicopathological variables, some known to be associated with nutritional status, were compared in 2 groups of horses in the post operative period following colic surgery; Group N (n = 15) were treated with PN and Group C (n = 15) were starved routinely.

RESULTS

Group N had significantly lower serum concentrations of triglycerides, total bilirubin, albumin and urea and significantly higher serum concentrations of glucose and insulin compared with Group C in the post operative period.

CONCLUSIONS

The control group of horses demonstrated significant clinicopathological evidence of starvation and the described PN protocol resulted in a demonstrably improved nutritional status in the treated horses.

POTENTIAL RELEVANCE

Further study is required to investigate clinical benefits and possible harmful side effects of post operative parenteral nutrition before the technique can be advocated for widespread use in practice.

Assessment of the welfare of working horses, mules and donkeys, using health and behaviour parameters

Working animals provide an essential transport resource in developing countries worldwide. Many of these animals are owned by poor people and work in harsh environments, so their welfare is a cause for concern. A protocol was developed to assess the welfare of working horses, mules and donkeys in urban and peri-urban areas, using direct observation of health and behaviour parameters. In this study, 4903 animals used for draught, pack and ridden work in Afghanistan, Egypt, India, Jordan and Pakistan were assessed between December 2002 and April 2003. The data showed that donkeys were more likely than mules or horses to demonstrate avoidance or aggressive behaviour towards an observer, while horses were most likely to make a friendly approach. Fewer than 8% of working equines had abnormal mucous membranes, ectoparasites or poor coat condition. Body lesions occurred predominantly in the areas of the breast/shoulder, withers and girth in all three species, with mules having the highest prevalence of lesions in these areas (22.5, 21.3 and 28.4%, respectively). Among horses and donkeys, the prevalence of these lesions was influenced by the type of work carried out. Lesions on the head, neck, ribs, flank and tail base were seen in less than 10% of animals. Across all three species approximately 70% of animals were thin, having a body condition score (BCS) of 2 or less on a scale of 1-5 (1, very thin; 5, very fat) and more horses were in very thin condition (BCS 1) than mules or donkeys. Over 75% of animals demonstrated limb deformities and abnormalities of gait. The results of this study are being used as the initial stage of a long-term strategy to inform priorities for welfare interventions in working equines and to establish a welfare benchmark. Subsequent stages will rank the welfare concerns identified, assess the contributing risk factors and implement specific interventions to address these risks. Following intervention, success in improving welfare will be measured by repetition of this protocol and comparison with the benchmark.