Interval prevalence of and factors associated with colic in horses hospitalized for ocular or orthopedic disease

Incidence and risk factors for complications associated with equine general anaesthesia for elective magnetic resonance imaging

BACKGROUND

Complications are a practical consideration for elective magnetic resonance imaging (MRI) studies performed under general anaesthesia but relatively little is known about their distribution and risk factors.

OBJECTIVES

To describe the incidence of complications associated with MRI performed under general anaesthesia at a large referral facility and evaluate potential risk factors for these complications.

STUDY DESIGN

Retrospective case-control study.

METHODS

Patient information and details of the MRI procedure were collected retrospectively from medical records of all horses that had undergone an MRI under general anaesthesia at the University of Pennsylvania, New Bolton Center, between September 2005 and April 2012. Complications and categorical variables were examined by chi-squared or Fisher's exact tests as appropriate. A mixed-effects logistic regression approach was used to evaluate associations between explanatory variables and the outcome variable (complications or pyrexia). A univariable screen was used to select variables (likelihood ratio test p < 0.2) for inclusion in the multivariable analysis. Statistical significance was inferred when p ≤ 0.05.

RESULTS

Complications were noted after MRI in 51 (17.4%) of 293 events eligible for inclusion. Complications included pyrexia (n = 35), pneumonia (n = 14), colic (n = 10), facial/nerve paralysis (n = 6), diarrhoea (n = 4), and other (n = 3). The odds of developing a post-anaesthetic complication were significantly decreased in horses that received peri-anaesthetic antimicrobials (OR 0.29, 95% CI 0.14-0.63, p = 0.002). Increased age (OR 0.87, 95% CI, 0.76-0.99, p = 0.03) and peri-anaesthetic antimicrobial administration (OR 0.23, 95% CI 0.08-0.65, p = 0.005) were associated with a decreased odds of developing pyrexia.

MAIN LIMITATIONS

Single centre retrospective design.

CONCLUSIONS

Potential complications including pyrexia, pneumonia and colic should be recognised when pursuing MRI under general anaesthesia. The administration of peri-anaesthetic antimicrobials decreased the odds of a complication and warrants consideration, particularly in horses that might be classified as high risk.

Peri-anaesthetic complications in 1798 equids undergoing high-field elective orthopaedic MRI at a tertiary referral hospital

BACKGROUND

Antimicrobial prophylaxis for elective orthopaedic magnetic resonance imaging (MRI) in equids is a topic of debate among practitioners and can have negative detrimental effects on patients if used unnecessarily.

OBJECTIVES

To describe the complications with elective orthopaedic MRI of horses, mules, and donkeys under general anaesthesia without the use of peri-anaesthetic antimicrobial prophylaxis at a single large tertiary referral centre. We hypothesised that horses, mules, and donkeys undergoing general anaesthesia for elective orthopaedic MRI, without antimicrobial prophylaxis, will not be at increased risk of complications, including increased risk of infectious respiratory disease.

STUDY DESIGN

Retrospective cross-sectional study.

METHODS

This retrospective study of 1798 systemically healthy equids that underwent elective orthopaedic MRI under general anaesthesia without peri-anaesthetic antimicrobial prophylaxis between January 2009 and May 2020.

RESULTS

A total of 1655 MRIs were included in the study, with 25 (1.5%) horses having complications. The most common complication was post-anaesthetic fever in 11 (0.7%) horses, of which 4 (0.2%) horses went on to develop pneumonia and one horse was diagnosed with equine herpesvirus (respiratory). Seven (0.4%) horses developed transient post-anaesthetic femoral neuropathy and 7 (0.4%) horses had mild post-anaesthetic colic that resolved with initial medical management. No horses were euthanised or died in this study.

MAIN LIMITATIONS

The retrospective nature of the study led to non-randomised case selection, and some records were incomplete.

CONCLUSIONS

These findings suggest that peri-anaesthetic antimicrobial prophylaxis may not be necessary for performance and sport horses undergoing general anaesthesia for elective orthopaedic MRI.

Colic incidence, risk factors, and therapeutic management in a working horse population in Tuban, Indonesia

Background and Aim

Colic is the primary problem affecting equestrian care worldwide. The primary cause of colic is digestive diseases; however, they can also affect organs from different systems in the abdominal region. In addition to a prior history of the disease and its treatment, risk factors may be assessed to determine the etiology of the disease in horses without or with a history of colic. This study aimed to present a summary of the incidence, risk factors, and medical procedures for colic in horses.

Materials and Methods

Based on owner reports, 223 horses in Tuban, Indonesia, suspected of having colic were investigated. During the investigation of clinical parameters, investigators went door-to-door with interested horse owners to gather information about potential risk factors related to equine colic. Information on horses diagnosed with colic was obtained from the medical records of treatment. A Chi-square test was used to investigate the potential association between the risk factors, medical protocol, and the outcome of colic in horses.

Results

Of the 187 cases, spasmodic colic was the most common (48.13%), but 17 (9.09%) had no definitive diagnosis. Poor body condition scores (χ2 = 58.73; p < 0.001), wheat bran feeding (χ2 = 26.79; p < 0.001), concentrate (χ2 = 10.66; p < 0.01), less access to water (χ2 = 128.24; p < 0.001), recurrence of colic (χ2 = 85.64; p < 0.001), no deworming program (χ2 = 54.76; p < 0.001), the presence of gastrointestinal parasites (χ2 = 56.79; p < 0.001), stressed physical activity (χ2 = 28.53; p < 0.001), and summer season (χ2 = 7.83; p < 0.01) were the risk factors for colic. We further reported that 185 (98.93%) patients who received the following medical interventions recovered: injection of non-steroidal anti-inflammatory drugs was necessary, Vitamin B complex (χ2 = 39.98; p < 0.001), fluid therapy (χ2 = 92.99; p < 0.001), and gastric intubation (χ2 = 4.09; p < 0.05).

Conclusion

The importance of colic was demonstrated in 187 (83.86%) of the 223 horses investigated in Tuban, Indonesia, documented. In this study, recommendations for medical procedures when colic risk factors have been determined are presented.

Pain scoring systems in hospitalized horses with ocular disease

BACKGROUND

Pain recognition in hospitalized horses is challenging, and the utility of pain scoring systems in horses with ocular disease has not been well-described.

HYPOTHESIS/OBJECTIVES

Evaluate the horse grimace scale (HGS) and behavior pain score (BPS) in hospitalized horses with ocular disease. We hypothesized that HGS and BPS would be associated with different clinical progressions.

ANIMALS

Privately owned horses hospitalized for ocular disease between September 2018 and September 2020.

METHODS

Retrospective observational study. The HGS and BPS were recorded daily throughout hospitalization. Clinical progressions were categorized as: (a) discharge from hospital after medical treatment, (b) ophthalmic surgery (eg, keratectomy, conjunctival flap, amniotic membrane transplantation, corneal transplant), or (c) enucleation. Temporal trends in HGS and BPS were assessed using linear regression. Correlations among slope, intercept, and progression were determined using the Kruskal-Wallis test.

RESULTS

Of 65 horses that met inclusion criteria, 29 (45%) were discharged after exclusively medical management, 28 (43%) underwent ophthalmic surgery, and 8 (12%) underwent enucleation. Two horses (3%) had 2 ophthalmic surgeries performed. The BPS scores at admission were higher in horses that were managed medically than in those that underwent enucleation (P = .01). Horses requiring enucleation had higher increases in HGS (P = .02) and BPS (P = .01) during hospitalization than horses that were medically managed and a higher increase in BPS (P = .04) than horses that required ophthalmic surgery.

CONCLUSIONS AND CLINICAL IMPORTANCE

Pain scoring may represent a useful tool for monitoring progression and response to treatment in hospitalized horses with ocular disease.

Retrospective evaluation of association between perioperative antimicrobial protocol and complications following elective equine synovial endoscopy

Background

Prophylactic perioperative antimicrobial protocols in equine synovial endoscopy have been described but not compared with respect to post‐operative outcomes and complications. Increasing antimicrobial resistance in equine practice and interest in promoting judicious use of antimicrobials has prompted reevaluation of drug selection and dosing strategies.

Objectives

To determine the frequency of and compare post‐operative complications following elective synovial endoscopy between horses receiving different perioperative antimicrobial protocols.

Methods

Records from the Colorado State University Veterinary Teaching Hospital were evaluated (2014–2018) and equine patients undergoing elective synovial endoscopy were identified. Patients undergoing endoscopy for sepsis or internal fixation were excluded. Patient signalment, clinician, joint and limb involved, perioperative antimicrobial regimen, number endoscopic portals and closure technique, and post‐operative complications including incidence of joint infection were recorded. Generalized linear models were used to estimate the odds of post‐operative complications.

Results

Elective synovial endoscopies of 516 horses in 537 procedures evaluating 761 synovial structures were performed. No horses developed post‐operative septic synovitis. Administration of post‐operative antimicrobials, type used and patient sex were all significantly associated with increased risk of complications, which were predominantly gastrointestinal‐related. Complication rates in horses receiving a single preoperative dose of cefazolin were lower than in horses receiving potassium penicillin, gentamicin or multiple doses. Complication rates were lower in females compared to castrated or intact males. Other factors evaluated (breed, age, surgeon, anaesthesia duration or hospitalization, joint/limb operated, number endoscopic portals) were not associated with increased risk of complications post‐operatively in this case population.

Conclusions

Prophylactic perioperative antimicrobial protocols in equine practice deserve periodic reconsideration due to increased antimicrobial resistance. Prolonged antimicrobial usage beyond the time of surgery was unnecessary to prevent septic synovitis following synovial endoscopy in this case population and was furthermore associated with an increased risk of gastrointestinal complications.

A retrospective evaluation of the effect of perianesthetic hydromorphone administration on the incidence of postanesthetic signs of colic in horses

OBJECTIVE

To describe the incidence of postanesthetic signs of colic (PASC) in horses and determine if perianesthetic administration of hydromorphone was associated with an increased risk of PASC.

STUDY DESIGN

Retrospective, cohort study.

ANIMALS

A total of 409 horses.

METHODS

Anesthesia and clinical records of horses admitted for various procedures from July 2018 to September 2019 were reviewed. Signs of colic and interventions were recorded up to 48 hours after anesthesia. A binomial logistic regression model was used to evaluate the association between the type of surgery, administration of hydromorphone, the duration of anesthesia and the incidence of PASC.

RESULTS

Overall, 25 (6.1%) horses developed PASC within 48 hours of general anesthesia. Of 60 horses that underwent colic surgery, 16 (26.7%) developed PASC. Of 349 horses that underwent noncolic procedures, nine (2.6%) developed PASC. Thus, the incidence of PASC was higher in horses that underwent colic surgery than in horses that underwent noncolic procedures [odds ratio (OR) = 13.74 (5.73-32.95)]. No effect of hydromorphone on the incidence of PASC was identified [OR = 1.61 (0.71-3.62)]. Longer procedures (>2 hours) were identified as an independent risk factor for PASC [OR = 4.13 (1.52-11.22)].

CONCLUSIONS

No association between hydromorphone and an increase in the incidence of PASC was identified. Anesthesia for colic surgery and duration of anesthesia were associated with an increased risk of PASC.

CLINICAL RELEVANCE

Hydromorphone did not increase the incidence of PASC in this population.

Risk factors for acute abdominal pain (colic) in the adult horse: A scoping review of risk factors, and a systematic review of the effect of management-related changes

Acute abdominal pain (colic) is the most common reason for emergency veterinary treatment in the horse. Consolidation of data through a systematic review is important to inform evidence-based medicine and clinical guidelines, but there are currently no published systematic reviews on colic in the horse. The aim of this study was to identify, categorize and appraise the evidence on factors associated with increased risk of developing abdominal pain (colic) due to gastrointestinal disease in the adult horse. A scoping review was performed to identify and categorize evidence on all risk factors for colic. A systematic review of management-related risk factors was then performed following PRISMA guidelines. Both searches were conducted in Medline, CAB Abstracts and Web of Science databases, and publications were assessed against inclusion and exclusion criteria. For the scoping review, study and participant characteristics of included publications and key results were extracted and tabulated. For the systematic review, cohort, case-control or cross-sectional studies investigating acute abdominal pain in horses within two weeks of management changes were assessed. Study characteristics, participant characteristics and study results of included publications for the systematic review were extracted and tabulated. Included publications were appraised using the Joanna Briggs Institute Critical Appraisal Tools for cohort, case-control and cross-sectional studies. The scoping review search identified 3,756 publications. Fifty eight studies met final inclusion criteria, and 22 categories of risk factors were identified. These were grouped into three broad areas: horse-related factors, management-related factors and environment-related factors. The largest body of evidence related to management change. The systematic review of management change identified 410 publications: 14 met inclusion criteria for analysis. These consisted of one cohort, eight case-control and five cross-sectional studies. The studies were conducted between 1990-2008, and the majority of studies were located in the USA (8/14) or UK (3/14). The risk factors related to management change that were assessed were feed, carer, exercise, pasture, water and housing. The largest bodies of evidence for increased risk of colic associated with management change were changes in feed (5/14 publications) and recent change in housing (3/14). Most studies (8/14) did not meet the JBI criterion on confounding factors. There was marked heterogeneity of study methodologies and measures. This is the first study to use a combined scoping and systematic review to analyse evidence for modifiable risk factors for a common condition in the horse. It provides a comprehensive review that will be a key resource for researchers, veterinary practitioners and horse owners. It identified modifiable risk factors associated with an increased risk of colic which should be a key target for preventative health programmes. The findings from the critical appraisal were used to develop recommendations for future research to improve the quality of evidence-based veterinary medicine.

A retrospective study of fecal output and postprocedure colic in 246 horses undergoing standing sedation with detomidine, or general anesthesia with or without detomidine

OBJECTIVE

To determine time to first passage of feces, total fecal piles and incidence of colic in the first 24 hours postprocedure in horses undergoing standing sedation with detomidine, or general anesthesia with or without detomidine.

STUDY DESIGN

Retrospective cohort study.

ANIMALS

A total of 246 horses.

METHODS

Records of all horses that underwent standing sedation or general anesthesia between December 2012 and March 2016 were reviewed. Horses aged <6 months, admitted for colic or cesarean section, with inadequate data, and those not administered xylazine and/or detomidine were excluded. Records included patient signalment, fasting duration, procedure performed, drugs administered, time to first feces, number of fecal piles during 24 hours postprocedure and mention of colic. Chi-square, Fisher's exact and Tukey's post hoc comparison tests were used. Parametric data were reported as mean ± standard deviation with significance defined as p <0.05.

RESULTS

In total, 116 and 57 horses underwent general anesthesia without detomidine (group GA) and with detomidine (group GA-D), respectively, and remaining 73 horses underwent standing sedation with detomidine (group S-D). Detomidine dose was significantly higher in group S-D than in group GA-D. Time to first feces was longer (7.1 ± 4.2 hours), and group S-D horses passed one fewer fecal pile (6.3 ± 2.4) than group GA horses. There was no interaction between detomidine treatment and preprocedure food withholding and the time to first feces or the number of fecal piles in the first 24 hours postprocedure. Overall, seven horses (2.8%) showed signs of colic (five, one and one in GA, GA-D and S-D, respectively).

CONCLUSIONS AND CLINICAL RELEVANCE

Detomidine administration, as part of an anesthetic protocol or for standing sedation procedures, should not be expected to contribute to postprocedural colic.

Surgical site infection associated with equine orthopedic internal fixation: 155 cases (2008-2016)

OBJECTIVE

To determine the prevalence of surgical site infection (SSI) after internal fixation and to identify risk factors for SSI and nonsurvival.

STUDY DESIGN

Retrospective study.

ANIMALS

One hundred fifty-five horses with long bone fractures or arthrodesis treated by internal fixation at 1 hospital between 2008-2016.

METHODS

Signalment, diagnosis, surgical repair, surgeon, surgical time, antimicrobial use, SSI onset, bacterial identification, and adjunct treatments were recorded. Perioperative variables were analyzed to identify risk factors associated with outcomes.

RESULTS

Surgical-site infection was reported in 22 of 155 (14.2%) horses, which is lower than what has been previously reported (P = .003). Horses with fetlock arthrodesis or ulnar fracture were more likely to develop SSI. Local prophylactic antimicrobial therapy was associated with an increased risk of SSI. Horses with SSI were 12 times (P < .0001) less likely to survive to discharge than horses without SSI. Horses with a fetlock or carpal arthrodesis or those with radial/humeral/femoral fractures were less likely to survive. No association was identified between open fractures, open reduction and internal fixation, or surgical times and SSI.

CONCLUSION

The prevalence of SSI in this population was lower than what has been previously reported. Horses with fetlock or carpal arthrodesis or radial/humeral/femoral fractures were at increased risk for SSI and/or nonsurvival to discharge. A protective role of local antimicrobial therapy for SSI could not be established.

CLINICAL RELEVANCE

The impact of SSI on outcomes of cases of equine internal fixation remains substantial. Identification of cases at higher risk of SSI should influence surgical technique, postoperative management, and early intervention when SSI is suspected. Additional investigation is warranted regarding local antimicrobial therapy.