Attitudes towards surgical safety checklists among American College of Veterinary Surgeons diplomates.

OBJECTIVE: To examine attitudes towards surgical safety checklists (SSCs) among American College of Veterinary Surgeons (ACVS) diplomates and to identify barriers to implementation. STUDY DESIGN: Qualitative online research survey. SAMPLE POPULATION: A total of 1282 current ACVS diplomates. METHODS: An anonymous online survey was distributed to current ACVS diplomates via email. ACVS diplomates were identified using publicly available data through the ACVS website. A total of 1282 surveys were electronically distributed, and respondents were given 4 weeks to respond. The survey consisted of 34 questions examining (1) demographic information, (2) current use of SSCs, (3) knowledge and attitudes towards SSCs, (4) perceived advantages and disadvantages to use of SSCs, (5) implementation strategies, and (6) potential reasons for noncompletion of SSCs. RESULTS: Survey response rate was 20% (257/1282). A total of 169 of 249 (67.9%) respondents indicated using SSCs. Respondents generally agreed that SSCs were proven to reduce surgical complications (196/249 [8.7%]) and did not perceive any disadvantages to use (100/138 [75.2%]). Respondents not using SSCs were more likely to perceive them as a waste of time (p < .001). The most common reasons for noncompletion of SSCs were forgetfulness (21/52 [39.6%]) and time constraints (19/52 [36.5%]). Improved training (72/138 [52.2%]) and modifying the SSC based on staff feedback (69/138 [50%]) were suggested as methods to improve SSC uptake. CONCLUSION: Respondents currently using SSCs were generally satisfied. Time constraints and memory related issues were common causes for noncompletion of SSCs. CLINICAL SIGNIFICANCE: Efforts to expand the implementation of SSCs in veterinary surgery should focus on improved engagement of relevant stakeholders and modification of the SSC to suit local conditions.

Clinical findings and outcomes of 153 dogs surgically treated for intestinal intussusceptions.

OBJECTIVE: To describe perioperative characteristics and outcomes of dogs surgically treated for intestinal intussusception. STUDY DESIGN: Multi-institutional, retrospective study. ANIMALS: One hundred fifty-three client-owned dogs with intestinal intussusception. METHODS: Dogs were included when they had undergone surgical treatment of a confirmed intestinal intussusception. Medical records were reviewed for demographics and clinical data, including surgical complications (graded 1-4). Follow-up was obtained via telephone interview with owners and referring veterinarians. RESULTS: Dogs had a median age of 10 months (range, 2-156), and the most common location for intussusception was ileocolic (66/153 [43%]). Most cases had no identifiable cause (104/155 [67%]). Intestinal resection and anastomosis (IRA) was performed in 129 of 153 (84%) dogs; enteroplication was performed in 28 of 153 (18%) dogs, including 13 with and 15 without IRA. Intraoperative complications occurred in 10 of 153 (7%) dogs, all involving intestinal damage during attempted manual reduction. The median duration of follow-up after discharge was 334 days (interquartile range, 15-990; range, 1-3302). Postoperative complications occurred in 53 of 153 (35%) dogs, including 22 of 153 (14%) with severe (grade 3 or 4) events. Diarrhea, regurgitation, and septic peritonitis were the most common postoperative complications; intussusception recurred in four of 153 (3%) dogs, all within 72 hours postoperatively. Fourteen-day postoperative mortality rate was 6%. CONCLUSION: Surgical treatment of intestinal intussusception was curative in most dogs, even when an underlying cause was not identified. Surgical complications were common, including a 14% risk of life-threatening short-term complications. CLINICAL SIGNIFICANCE: Surgical treatment of intestinal intussusception offers an excellent prognosis, but the potential life-threatening complications should be considered.

Stump Pyometra Secondary to Human Topical Estrogen Hormone Exposure in a Spayed Female Chihuahua.

A 6 yr old female spayed Chihuahua was presented for evaluation of intermittent vulvar discharge, stranguria, and vomiting. This dog had an ovariohysterectomy as a puppy and did not experience any evidence of estrous until 4.5 yr later. The owner had been using a topical hormone replacement therapy (estradiol spray) twice daily for the duration of the dog's clinical signs of 1 yr. On presentation, the dog had truncal alopecia, comedones, enlarged vulva with a malodorous, and purulent discharge. Bloodwork showed a leukocytosis with a neutrophilia, döhle bodies, and moderate toxic changes. An abdominal ultrasound revealed an enlarged uterine stump with a thickened wall, ovoid projection cranially, and echogenic luminal contents. An exploratory laparotomy identified an enlarged cervical stump. Histopathology revealed chronic suppurative vaginitis with endometritis, necrosis, and intraluminal coccoid bacteria. The dog recovered well from surgery. A baseline estrogen level post operatively was measured at 56.4 pg/mL (<50.0 pg/mL for a spayed bitch), at this time, the dog had been separated from the owner for 7 days. After surgery, the clinical signs disappeared, and the dog's dermatologic changes improved. This is the first reported case of stump pyometra following exposure to the owner's topical estradiol replacement medication.

Owner Perception of Outcome Following Permanent Tracheostomy in Dogs.

The purpose of this study was to evaluate owner perception of outcome following permanent tracheostomy (PT) in dogs. Medical records of dogs who received PT from 2002 to 2016 were reviewed. A questionnaire was given to owners verbally or by e-mail to ascertain their perception of their dog's outcome after PT. Median time to questionnaire administration from PT surgery was 608 days (64-3,708). Owner satisfaction after PT was high (89.7%), with the majority stating they would have the procedure performed again (79.5%). Owners reported an improvement in their dog's personality (30.8%) and increased activity (41%). Median survival time was 1,825 days (64-2,663), with 6 of 39 dogs (15.4%) alive at study end. Of the 33 dogs who died, 11 (33.3%) died from underlying respiratory conditions suspected to be related to the PT. The overall complication rate was 82.1%, with mucus secretion being the most common. Revision surgery was required in 30.8% of dogs (most commonly due to skin occlusion), and aspiration pneumonia occurred in 17.9% of dogs. Overall, owner satisfaction after PT in dogs is high despite intensive postoperative management, and long survival times can be achieved.

Axial Pattern Flaps.

Axial pattern flaps are based on a direct cutaneous artery and vein supplying a segment of skin. They provide a large, robust option for large wound closure. Many different axial pattern flaps have been described to provide options for closure of wounds located from the nose to the tail. All axial pattern flaps require good surgical technique and careful attention to detail while developing of the flap.

Granulomatous Inflammatory Response to a Microchip Implanted in a Dog for Eight Years.

An 8 yr old neutered male springer spaniel dog was referred to Texas A&M University, College of Veterinary Medicine for a large, firm, fixed mass, located in the dorsal cervical tissue. The dog was otherwise healthy and had undergone microchip implantation approximately 8 yr prior. Radiographs, ultrasound, and microchip scanner confirmed the presence of a microchip within the mass. The microchip and associated mass were surgically excised, and histopathologic examination revealed granulomatous inflammation surrounding a cracked microchip. This case represents the first report of a granulomatous inflammatory response to a microchip 8 yr after implantation in a dog and highlights an important differential diagnosis.

Primary splenic torsion in dogs: 102 cases (1992-2014).

OBJECTIVE: To determine the percentage of dogs surviving to hospital discharge and identify factors associated with death prior to hospital discharge among dogs undergoing surgery because of primary splenic torsion (PST). DESIGN: Retrospective case series. ANIMALS: 102 client-owned dogs. PROCEDURES: Medical records of dogs with a confirmed diagnosis of PST that underwent surgery between August 1992 and May 2014 were reviewed. History, signalment, results of physical examination and preoperative bloodwork, method of splenectomy, concurrent surgical procedures, perioperative complications, duration of hospital stay, splenic histopathologic findings, and details of follow-up were recorded. Best-fit multivariate logistic regression was performed to identify perioperative factors associated with survival to hospital discharge. RESULTS: 93 of the 102 (91.2%) dogs survived to hospital discharge. German Shepherd Dogs (24/102 [23.5%]), Great Danes (15/102 [14.7%]), and English Bulldogs (12/102 [11.8%]) accounted for 50% of cases. Risk factors significantly associated with death prior to hospital discharge included septic peritonitis at initial examination (OR, 32.4; 95% confidence interval [CI], 2.1 to 502.0), intraoperative hemorrhage (OR, 22.6; 95% CI, 1.8 to 289.8), and postoperative development of respiratory distress (OR, 35.7; 95% CI, 2.7 to 466.0). Histopathologic evidence of splenic neoplasia was not found in any case. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that the prognosis for dogs undergoing splenectomy because of PST was favorable. Several risk factors for death prior to discharge were identified, including preexisting septic peritonitis, intraoperative hemorrhage, and postoperative development of respiratory distress.

Palatal erosion and oronasal fistulation following covered nasopharyngeal stent placement in two dogs.

Treatment options for dogs with nasopharyngeal stenosis include fluoroscopic placement of metallic stents. Reported complications include entrapment of hair and food, obstruction and persistent nasal discharge. Two toy breed dogs were examined for persistent nasal discharge and halitosis at 4 and 20 months after placement of permanent metallic stents for acquired nasopharyngeal stenosis. Full thickness defects were found in the palate of both dogs, with extensive communication between the mouth and the nasal passages. Portions of the metal stent were observed within the lesion in both patients. Additional treatment was declined by the owner of one dog; the stent was removed through the fistula in the other dog. Palatal erosion with secondary oronasal fistulation is a potential complication of nasopharyngeal stent placement in dogs.