Clinical relevance of positive intraoperative bacterial culture in tibial plateau leveling osteotomy in dogs: a retrospective study.

BACKGROUND: Tibial plateau leveling osteotomy (TPLO) belongs to the most frequently used surgical method for the treatment of cranial cruciate ligament rupture in dogs. Surgical site infection (SSI) is one of the possible postoperative complications. The aim of this study was to evaluate the diagnostic value of intraoperative bacterial culture as a tool for the detection of intraoperative bacterial contamination progressing to infection development in canine TPLO. Electronic patient records from dogs who underwent TPLO between January 2018 to December 2020 were retrospectively reviewed. Intraoperative bacterial culture results, used antimicrobial drugs and presence of SSI were recorded. RESULTS: Ninety-eight dogs were included in the study. SSI rate was 10.2%. All dogs who developed SSI (n = 10) had negative intraoperative bacterial cultures. None of the dogs with positive intraoperative bacterial culture (n = 6) developed SSI. The most cultured bacteria causing SSI was Staphylococcus pseudintermedius (n = 4). CONCLUSIONS: Intraoperative bacterial culture in dogs undergoing TPLO is not suitable as a predictor of surgical site infection.

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.

Medial versus lateral transcondylar screw placement for canine humeral intracondylar fissures: A randomized clinical trial.

OBJECTIVE: To determine the influence of screw direction on complications following transcondylar screw placement for the treatment of canine humeral intracondylar fissures (HIFs). STUDY DESIGN: Equivalence, parallel group, randomized clinical trial. SAMPLE POPULATION: Fifty-two client owned dogs (73 elbows). METHODS: Transcondylar screw placement was randomized to either a medial or lateral approach. The primary outcome was the incidence of postoperative complications. RESULTS: There were 37 cases in the lateral approach group and 36 cases in the medial approach group. There was a significantly greater proportion of postoperative complications following placement of transcondylar screws from a lateral to medial direction (p = .001). There were seven cases with complications (19%) in the medial approach group versus 23 cases with complications (62%) in the lateral approach group. The majority of complications were seromas (n = 13) and surgical site infections (n = 16) with 4 complications requiring further surgery. Implant area moment of inertia (AMI), normalized to bodyweight, was lower in dogs with a major complication (p = .037). CONCLUSION: Transcondylar screws placed from lateral to medial for canine HIFs had a greater proportion of postoperative complications in this randomized clinical trial design. Implants with a lower AMI, relative to bodyweight, were more likely to lead to major complications. CLINICAL SIGNIFICANCE: We recommend placing transcondylar screws from medial to lateral for canine HIFs to reduce the risk of postoperative complications. Relatively small diameter implants had an increased risk of major complications.

Complications and Long-Term Outcomes after Combined Tibial Plateau Leveling Osteotomy and Tibial Tuberosity Transposition for Treatment of Concurrent Cranial Cruciate Ligament Rupture and Grade III or IV Medial Patellar Luxation.

OBJECTIVES: This study aims to report complications and long-term outcomes of combined tibial plateau leveling osteotomy and tibial tuberosity transposition (TPLO-TTT) for treatment of concurrent cranial cruciate ligament rupture and medial patellar luxation (MPL). STUDY DESIGN: This is a retrospective study. Dogs that underwent TPLO-TTT for treatment of combined cranial cruciate ligament rupture and grade III or IV MPL were included. Signalment, fixation method, and complications were recorded. Long-term outcome assessment (minimum 1 year postoperatively) was performed through clinical and radiographic reexamination at the authors' institution. RESULTS: Twenty-four stifles (22 dogs) were included. Twenty-one stifles had a grade III MPL, and 3 stifles had grade IV MPL. Four major complications consisting of surgical site infection (n = 3) and recurrent grade II MPL (n = 1) were observed. Dogs with surgical site infections were successfully treated with implant removal and oral antibiotics. No additional surgery was performed for the patient with recurrent MPL as no signs of lameness were observed. Minor complications occurred in five cases. At long-term evaluation (median: 27 months; range: 12-67 months), 21/22 dogs were clinically sound and 23/24 stifles had a complete resolution of MPL. CONCLUSION: TPLO-TTT can be considered as an effective surgical option to treat patients with concurrent cranial cruciate ligament rupture and MPL with a relatively low major complication rate. Owners should be warned of the potential need for implant removal.

Evaluation of a client questionnaire at diagnosing surgical site infections in an active surveillance system.

OBJECTIVE: To report sensitivity, specificity, predictive values and accuracy of a client questionnaire at diagnosing surgical site infections (SSIs) and describe the impact of active surveillance on SSI detection. STUDY DESIGN: Prospective, cohort study. ANIMALS: Dogs and cats undergoing soft tissue or orthopedic surgery over a 12-month period at a referral hospital. METHODS: Clients were emailed a questionnaire 30 days postoperatively, or 90 days where an implant was used. Three algorithms were developed to diagnose SSIs using one or both of two criteria: (1) presence of any wound healing problems; (2) wound dehiscence or antibiotic prescription, and either purulent discharge or two or more clinical signs (redness, pain, heat, swelling, discharge). Algorithmic diagnoses were compared to gold standard diagnoses made by veterinarians. RESULTS: Of 754 surgical procedures, 309 responses were completed with 173 corresponding gold standard diagnoses. The most accurate algorithm determined "SSI" or "No SSI" from 90.2% of responses with 95.5% (92.4-98.6) accuracy, 82.6% (77-88.3) sensitivity, 97.7% (95.5-100) specificity, 86.4% (81.2-91.5) positive predictive value, and 97% (94.5-99.6) negative predictive value. "No SSI" was diagnosed in responses not meeting criterion 1, and "SSI" in responses meeting criteria 1 and 2. "Inconclusive" responses, comprising 9.8% of responses, met criterion 1 but not 2. Overall SSI rate was 62/754 (8.2%) and 12/62 (19.4%) SSIs were detected by active surveillance only. CONCLUSION: Use of this client questionnaire accurately diagnosed SSIs; active surveillance increased SSI detection. CLINICAL SIGNIFICANCE: Surveillance of SSIs should be active and can be simplified by using a client questionnaire and algorithmic diagnoses, allowing automated distribution, data collection and analysis.

Photobiomodulation therapy in dogs undergoing TPLO after cranial cruciate ligament rupture shows promise but no statistically significant difference in a randomized trial.

OBJECTIVE: Effect of photobiomodulation therapy (PBMT) in patients with CCLR after TPLO surgery by measuring C-reactive protein (CRP), percentage weight bearing, lameness using a short form of a composite measure pain scale, evaluated by the clinician and owners, and surgical site infection. SAMPLE: 54 client-owned dogs with CCLR undergoing unilateral TPLO surgery were enrolled in this study between April 5, 2021, through April 10, 2022. METHODS: The study population was randomly assigned to either a treatment group receiving PMBT (24 dogs) or a control group (30 dogs). PMBT was performed on the treatment group immediately after induction, and 6 hours, 24 hours, 48 hours, and 8 weeks postoperatively. The control group received sham PMBT (device turned off) at the same time. Evaluation of CRP, CMPS-SF, evidence of SSI, and %WB were evaluated for all dogs 24 hours preoperatively, and then 24 hours, 48 hours, and 8 weeks postoperatively. Owners completed CMPS-SF and subjective evaluations weekly for 8 weeks postoperatively. RESULTS: No statistically significant differences were found between treatment groups when evaluating CRP, %WB, and CMPS-SF by the clinician and weekly evaluation of the CMPS-SF by owners. Although no statistically significant differences were found in patients developing surgical site infections between treatment groups, SSI was only observed in patients in the control group (5/30, 16.6%). Most were minor/superficial infections (4/30 13.3%), and a single dog (1/30, 3.3%) had a major/deep surgical site infection. CLINICAL RELEVANCE: Although with promising but not statistically significant differences between groups, surgical site infections may be reduced after PBMT application.

Influence of antiseptic lavage during tibial plateau leveling osteotomies on surgical site infection in 1422 dogs.

OBJECTIVE: To determine the influence of preclosure antiseptic versus saline lavage on surgical site infections (SSI) in dogs following tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: A multicenter retrospective study. SAMPLE POPULATION: Dogs treated with TPLO (n = 1422) between December 2019 and October 2021. METHODS: The medical records of dogs treated with TPLO were reviewed for preclosure antiseptic lavage or saline irrigation. Additional collected data included signalment, unilateral or bilateral TPLO, postoperative administration of antimicrobial medications, antibiotic agent, surgeon, and development of SSI within 90 postoperative days. Eleven factors were analyzed for association with SSI using univariate and multivariate analysis. RESULTS: Data were collected from the records of 519 dogs treated with antiseptic lavage and 903 dogs treated with saline lavage during TPLO. Surgical site infections were diagnosed more frequently in dogs that received preclosure antiseptic lavage (77/519, 14.84%) than those with saline irrigation (80/903, 8.86%) (p = .001). Single session bilateral TPLO increased the odds of SSI by 2.5x (p = .004). The odds of SSI increased by 11% (p = .001) for every 5 kg increase in bodyweight. Postoperative administration of antimicrobials decreased the risk of SSI (p = .008). CONCLUSION: The preclosure antiseptic lavage tested here did not decrease the incidence of SSI after TPLO. CLINICAL SIGNIFICANCE: The results of this study do not provide evidence to support preclosure antiseptic lavage during TPLOs.

Use of liposomal bupivacaine in dogs and cats undergoing gastrointestinal surgery is not associated with a higher rate of surgical site infections or multidrug-resistant infections.

OBJECTIVE: To report the rate of surgical site infections (SSIs) after clean-contaminated and dirty gastrointestinal surgery in dogs and cats that did and did not receive incisional infiltration of Nocita and report the bacteria isolated. ANIMALS: Client-owned dogs (n = 211) and cats (78). METHODS: Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and the University of Florida Small Animal Hospital between July 1, 2020, and April 1, 2023, were reviewed for surgical procedures, presence of preoperative septic peritonitis, use of Nocita, perioperative antibiotics administered, postoperative antibiotic use, SSI development postoperatively, and aerobic bacteria isolated. RESULTS: 7 of 124 (5.6%) dogs that received Nocita and 9 of 87 (10.2%) that did not receive Nocita developed an SSI. No dogs presenting with septic peritonitis and given Nocita (n = 5) developed an SSI. Two of 55 (3.6%) cats that received Nocita and 1 of 23 (4%) that did not receive Nocita developed an SSI. Multidrug-resistant (MDR) Escherichia coli was the most common aerobic bacteria isolated from SSIs (n = 3), and MDR bacteria were isolated commonly from both groups (4). CLINICAL RELEVANCE: Use of Nocita for gastrointestinal surgery in dogs and cats is not associated with higher rates of SSI than published rates of SSI after gastrointestinal surgery. Use of Nocita in dogs with preoperative septic peritonitis is not associated with the development of SSI. MDR bacteria are commonly isolated via culture from both dogs that received Nocita and those that did not.

Effect of hospitalisation on the rate of surgical site infection in dogs with Penrose drains.

OBJECTIVES: The aim of this study is to retrospectively report complication and infection rates associated with the use of Penrose drains in a large population of dogs; and to compare complication and infection rates of dogs hospitalised for maintenance of their Penrose drains with those that were discharged home with their drains in place. MATERIALS AND METHODS: We performed a retrospective search of medical records from 2014 to 2022 for dogs that had a Penrose drain placed into a wound in one institution. Our population was sub-divided into dogs discharged home with a drain in place; dogs discharged only after drain removal; and dogs recovered part of the time in hospital and part at home (with the drain in situ). Postoperative complications were graded using the Clavien-Dindo scale. RESULTS: Two hundred and eight dogs were included. The overall complication rate was 40.9% (85/208), with most complications considered minor. The overall infection rate was 16.9% (35/207). Dogs discharged home with the drain in situ <24 hours after surgery (n=136) had similar complication (39.0%) and infection (16.2%) rates to dogs kept hospitalised for drain care (n=50, 42.9%, 18.4%) and dogs kept hospitalised for >24 hours but discharged with the drain in situ (n=18, 50.0%, 22.2%). CLINICAL SIGNIFICANCE: Our study results show no significant influence on the complication or infection rates between dogs that were hospitalised for drain care and those discharged home with drains in situ within 24 hours of surgery.

Reading man flap in four dogs: a case series.

BACKGROUND: The reading man flap is a novel technique in human medicine for the closure of cutaneous circular defects. To the best of our knowledge, no recent clinical studies have described this procedure in small animals. CASE PRESENTATION: In this case series, we present four dogs in which neoplasms were reconstructed using the reading man procedure, which is a double-advancement transposition subdermal flap. The reading man flap was applied in wound revision after surgical removal of a neoplasm in two dogs and in the closure following the excision of a neoplasm in another two dogs. Successful tension-free closure of the lesion site was achieved in all four patients. The postoperative period was uneventful in all patients, and there was no flap necrosis or surgical site infection, although surgical site infection preceded in two cases. Minor complications included partial suture dehiscence in one dog and seroma formation in two dogs. Only one dog required a second anesthesia to insert an active drainage system. The follow-up examination of all four dogs revealed no further complications with the reading man flap at time of the latest wound reevaluation conducted by the surgeon. CONCLUSION: The reading man flap is a well-vascularized fasciocutaneous flap that provides tension-free closure owing to its asymmetrical Z-plasty. It is a simple-to-use option for the closure of circular skin lesions in dogs.

Retrospective comparison of modified percutaneous cystolithotomy (PCCLm) and traditional open cystotomy (OC) in dogs: 218 cases (2010-2019).

OBJECTIVE: To compare short- and long-term clinical variables between dogs undergoing a modified percutaneous cystolithotomy (PCCLm) and open cystotomy (OC) and evaluate for risk factors associated with complications and outcomes within the groups. STUDY DESIGN: Retrospective study. ANIMALS: A total of 218 dogs. METHODS: Records were reviewed for dogs that underwent PCCLm or OC between January 2010 and December 2019. Signalment; history and diagnostic findings; procedural, anesthetic, and hospitalized care data; complications; urolith recurrence; and follow-up were recorded. Logistic regression analysis was used to evaluate effects of clinical variables on outcomes within PCCLm and OC groups and to identify significant categorical variables between PCCLm and OC groups. Two sample t-tests were used to identify significant numerical variables between PCCLm and OC groups. RESULTS: A total of 60.1% (131/218) of dogs underwent the PCCLm procedure and 39.9% (87/218) of dogs underwent the OC procedure. Anesthesia time (p < .001) was significantly longer in the OC group. No significant difference in incomplete urolith removal was noted between groups. Although surgical site infection and inflammation rates were not significantly different between OC and PCCLm groups, incisional infections were significantly associated with complications occurring during PCCLm (p = .027). Significantly reduced postoperative lower urinary tract signs (p = .022) were noted in the PCCLm group. CONCLUSION: The PCCLm may result in reduced lower urinary tract signs postoperatively compared to OC, but other clear advantages of the PCCLm were not identified in this study. CLINICAL SIGNIFICANCE: PCCLm procedures are an effective alternative to OC for urolith removal in dogs.

Use of an equine compression suit to manage a deep axillary wound in a horse.

PURPOSE: To describe the use of an equine compression suit to manage a deep axillary wound in a Thoroughbred filly with bilateral pneumothorax. CASE SUMMARY: A 2-year-old Thoroughbred filly was referred for management of a deep wound to the left axilla. Packing and bandaging of the area were initially attempted, but this became repeatedly dislodged, and bandaging was discontinued. The filly subsequently developed widespread subcutaneous emphysema, and the wound was slow to granulate. Acute onset respiratory distress occurred 11 days after admission, secondary to bilateral worsening pneumothorax, and required placement of a chest drain. A commercially available equine compression suit was then successfully used to hold a primary dressing in place. This resulted in a marked improvement in the subcutaneous emphysema and pneumothorax. Wound granulation subsequently progressed well, and the filly was discharged from the clinic on day 36. UNIQUE INFORMATION PROVIDED: This case report highlights the potential applicability of a compression suit as an alternative to a stent to effectively prevent entry of air and successfully manage axillary wounds in the horse. It was also noted how delayed the progression of a pneumothorax can be after inadequate bandaging of a deep wound in the axillary region. The compression suit provided an alternative means of securing a dressing onto an awkwardly placed wound and may be useful in locations other than the axilla.

Prospective, randomized, double blind comparison of suture materials with and without triclosan in dogs undergoing tibial plateau leveling osteotomy.

Objectives: To determine if triclosan-impregnated suture decreases surgical site infection rates after tibial plateau leveling osteotomy (TPLO) in dogs. Sample population: There were 116 dogs with naturally occurring cranial cruciate ligament disease presenting for treatment with TPLO. Procedures: Written consent was obtained by all clients in order to be included in this study. Dogs were randomly assigned a suture type immediately before the start of anesthesia. Infection rates were compared between the suture groups, as were the gender, duration of anesthesia, duration of surgery, age of dog, weight, length of incision, and stifle side. Direct examination by a veterinarian was conducted at 24 h, 10 to 14 d, and 8 to 12 wk after surgery. If the dogs did not return for direct examination, owners were contacted by a veterinarian and phone interviews were conducted. Results: Overall, 12.9% of the incisions were diagnosed with a surgical site infection (SSI). The SSI rate for dogs that received the triclosan suture was 5.35% (3/56), and the rate for dogs that received the regular suture was 19.64% (11/56), with P = 0.016. The duration of anesthesia, duration of surgery, age, weight, length of incision, and right versus left stifle did not show a significant difference in infection rates. The suture type did have a significant effect, and triclosan-impregnated suture had a decreased infection rate when compared to regular suture. Gender also had a significant effect, with P = 0.032. Conclusion: Triclosan-impregnated suture decreased SSI when used for closure in dogs undergoing TPLO. Triclosan-impregnated suture may be considered a material of choice to close surgical wounds at risk of SSI when implants are used.

Comparaison prospective, randomisée, en double aveugle des matériaux de suture avec et sans triclosan chez les chiens subissant une ostéotomie de nivellement du plateau tibial. Objectifs: Déterminer si la suture imprégnée de triclosan diminue les taux d'infection du site opératoire après une ostéotomie de nivellement du plateau tibial (TPLO) chez le chien. Échantillon de population: Il y avait 116 chiens avec une pathologie naturelle du ligament croisé crânial se présentant pour un traitement avec TPLO. Procédures: Un consentement écrit a été obtenu par tous les clients afin d'être inclus dans cette étude. Les chiens ont été répartis au hasard à un type de suture immédiatement avant le début de l'anesthésie. Les taux d'infection ont été comparés entre les groupes de suture, de même que le sexe, la durée de l'anesthésie, la durée de la chirurgie, l'âge du chien, le poids, la longueur de l'incision et le côté du grasset. Un examen direct par un vétérinaire a été effectué à 24 h, 10 à 14 j et 8 à 12 semaines après la chirurgie. Si les chiens ne revenaient pas pour un examen direct, les propriétaires étaient contactés par un vétérinaire et des entretiens téléphoniques étaient menés. Résultats: Dans l'ensemble, 12,9 % des incisions ont été diagnostiquées avec une infection du site opératoire (SSI). Le taux de SSI pour les chiens ayant reçu la suture au triclosan était de 5,35 % (3/56) et le taux pour les chiens ayant reçu la suture régulière était de 19,64 % (11/56), avec P = 0,016. La durée de l'anesthésie, la durée de la chirurgie, l'âge, le poids, la longueur de l'incision et le grasset droit versus le gauche n'ont pas montré de différence significative dans les taux d'infection. Le type de suture avait un effet significatif et la suture imprégnée de triclosan avait un taux d'infection réduit par rapport à la suture ordinaire. Le sexe avait également un effet significatif, avec P = 0,032. Conclusion: La suture imprégnée de triclosan a diminué le SSI lorsqu'elle était utilisée pour la fermeture de l'incision chez les chiens subissant une TPLO. La suture imprégnée de triclosan peut être considérée comme un matériau de choix pour fermer les plaies chirurgicales à risque de SSI lorsque des implants sont utilisés.(Traduit par Dr Serge Messier).

Correlation between the Insertion Side of a Transcondylar Screw for the Surgical Management of Humeral Intracondylar Fissures in Dogs and the Incidence of Postoperative Surgical Site Infection.

OBJECTIVE: An increased rate of surgical site infection (SSI) following treatment of canine humeral intracondylar fissure (HIF) with a lateromedially (LM) placed transcondylar screw (TCS) compared with a mediolateral (ML) TCS has been previously postulated. We hypothesized that the direction of insertion of the TCS would not affect the incidence of postoperative SSI. STUDY DESIGN: It was single-centre retrospective study. Dogs with HIF confirmed by computerized tomography, treated by TCS placement (between 2008 and 2019) and with a minimum follow-up of 12 weeks, were included. The following data were recorded: signalment, presenting clinical signs, direction of placement and size of the utilized TCS, surgical and anaesthetic times, concurrent surgical procedures, presence of concomitant elbow pathology, perioperative and postoperative antibiotic usage and postoperative complications. Recorded data were analysed with a multinomial logistic regression model with a p-value less than or equal to 0.05. RESULTS: Thirty-five dogs (46 elbows) met the inclusion criteria. Median clinical follow-up interval was 52 weeks. Seven of thirty-one elbows with a ML TCS, and 4/15 elbows with a LM TCS developed SSI. Four of nine dogs that underwent bilateral single-surgery TCS placement developed SSI unilaterally. CONCLUSION: No significant difference was shown in short-term SSI occurrence between the ML and the LM direction of placement of the TCS.

Number of previous surgeries and antibiotic resistance decreases the success of local administration of antibiotic-impregnated poloxamer 407 hydrogel when managing orthopedic surgical site infections in dogs.

OBJECTIVE: To report the outcome of locally administered antibiotic-impregnated poloxamer 407 (P407) hydrogel in dogs diagnosed with orthopedic surgical site infections (SSIs) and to identify risk factors for treatment failure. ANIMALS: 34 client-owned dogs diagnosed with an orthopedic surgical site infection treated with local antibiotic-impregnated P407 hydrogel. PROCEDURES: Medical records were reviewed of dogs receiving antibiotic-impregnated P407 hydrogel for an active orthopedic SSI between March 2018 and December 2020. The rate of successful infection clearance was calculated. Risk factors for failed treatment were evaluated with statistical analyses. RESULTS: 34 dogs met the inclusion criteria. Vancomycin-impregnated P407 hydrogel (20 mg/mL) was implanted in all dogs. The rate of infection clearance was 77%. Each unit increase in the number of surgeries performed at a site before gel implantation decrease the chance of successful infection clearance by 25% (P = .005; unit OR, 0.25; 95% CI, 0.08 to 0.81). Presence of multidrug or methicillin resistance increased risk for treatment failure by 7.69 times (P = .042; OR, 0.13; 95% CI, 0.01 to 1.14). No adverse events related to gel administration were seen. CLINICAL RELEVANCE: Treatment outcomes were negatively impacted by the presence of multidrug or methicillin resistance and by an increased number of surgeries before gel implantation. Local administration of antibiotic-impregnated P407 hydrogel had a high success rate with no adverse effects in this population. Local antibiotic gel administration may improve treatment outcomes in dogs with complicated SSI.

[Unclear fertility-related losses in cattle - a pilot study to evaluate the occurrence of bovine endometrosis]. / Unklare fruchtbarkeitsbedingte Abgänge beim Rind ­ eine Pilotstudie zur Evaluation des Vorkommens boviner Endometrose.

INTRODUCTION: With every surgical procedure there is a risk of postoperative infection (surgical site infection = SSI). This risk of infection can be influenced by various factors, including perioperative antibiotic prophylaxis. In terms of antibiotic stewardship, antibiotics should only be used if there is a proven benefit for the patient. However, this advantage has not yet been conclusively proven, especially for clean and clean-contaminated surgeries. The aim of our study was to document various relevant influencing factors on the infection rate after clean and clean-contaminated surgeries in dogs and cats. In particular, it was documented to what extent a reduced use of antibiotics affects the infection rate in the context of all influencing factors. Over a period of eleven months, 807 clean and clean-contaminated surgeries in dogs and cats were prospectively analyzed with possible influencing factors (gender, ASA classification, underlying endocrinological diseases, duration of anesthesia, duration of surgery, type of surgery, perioperative antibiotic prophylaxis (POA), duration of hospitalization) affecting the infection rate. After surgery all cases were followed up either 30 or 90 days, if implants were used. The effect of the various factors was evaluated using multivariable logistic regression analysis. SSI was detected in 25/664 clean and 10/143 clean-contaminated surgeries. Longer hospitalization, without antimicrobial prophylaxis, and male animals had a significantly higher risk of SSI. In clean surgeries, SSI occurred in 2,3 % of all cases with POA and 5,3 % without POA. The SSI in clean-contaminated was 3,6 % with POA and 9 % without. This difference resulted mainly from the results of osteosynthesis, gastrointestinal and skin surgeries. However, other types of surgeries, such as castrations, neurological interventions, abdominal and thoracic surgeries, and surgeries in the head and neck region, showed comparable infection rates with and without POA.

INTRODUCTION: Toute intervention chirurgicale comporte un risque d'infection postopératoire (infection du site opératoire = ISO). Ce risque d'infection peut être influencé par différents facteurs, dont l'antibioprophylaxie périopératoire. En termes de gestion responsable des antibiotiques, les antibiotiques ne devraient être utilisés que s'il existe un avantage prouvé pour le patient. Cependant, cet avantage n'a pas encore été prouvé de manière concluante, en particulier pour les chirurgies propres et propres-contaminées. L'objectif de notre étude était de documenter divers facteurs d'influence pertinents sur le taux d'infection après des chirurgies propres et propres-contaminées chez les chiens et les chats. Nous avons en particulier cherché à savoir dans quelle mesure une utilisation réduite des antibiotiques affecte le taux d'infection en tenant compte de tous les facteurs d'influence. Sur une période de onze mois, 807 chirurgies propres et contaminées chez des chiens et des chats ont été analysées prospectivement avec les facteurs d'influence possibles (sexe, classification ASA, maladies endocrinologiques sous-jacentes, durée de l'anesthésie, durée de la chirurgie, type de chirurgie, prophylaxie antibiotique périopératoire (POA), durée de l'hospitalisation) affectant le taux d'infection. Après la chirurgie, tous les cas ont été suivis durant soit 30 soit90 jours si des implants avaient été utilisés. L'effet des différents facteurs a été évalué par une analyse de régression logistique multivariable. Des ISO ont été détectées dans 25/664 chirurgies propres et 10/143 chirurgies contaminées propres. Une hospitalisation plus longue sans prophylaxie antimicrobienne ainsi que les animaux mâles présentaient un risque significativement plus élevé d'ISO. Dans les chirurgies propres, les ISO sont survenues dans 2,3 % des cas avec POA et 5,3 % sans POA. Dans les opérations propres-contaminées, les ISO étaient de 3,6 % avec POA et de 9 % sans POA. Cette différence était principalement due aux résultats des ostéosynthèses, des chirurgies gastro-intestinales et cutanées. En revanbche, d'autres types de chirurgies, comme les castrations, les interventions neurologiques, les chirurgies abdominales et thoraciques et les chirurgies de la tête et du cou ont montré des taux d'infection comparables avec et sans POA.

[Prospective analysis of risk factors for perioperative infections in clean and clean-contaminated surgeries in dogs and cats with special reference to perioperative and postoperative antibiotic use]. / Prospektive Analyse von Risikofaktoren für perioperative Infektionen bei sauberen und sauber-kontaminierten Eingriffen bei Hund und Katze unter besonderer Berücksichtigung des perioperativen und postoperativen Antibiotikaeinsatzes.

INTRODUCTION: With every surgical procedure there is a risk of postoperative infection (surgical site infection = SSI). This risk of infection can be influenced by various factors, including perioperative antibiotic prophylaxis. In terms of antibiotic stewardship, antibiotics should only be used if there is a proven benefit for the patient. However, this advantage has not yet been conclusively proven, especially for clean and clean-contaminated surgeries. The aim of our study was to document various relevant influencing factors on the infection rate after clean and clean-contaminated surgeries in dogs and cats. In particular, it was documented to what extent a reduced use of antibiotics affects the infection rate in the context of all influencing factors. Over a period of eleven months, 807 clean and clean-contaminated surgeries in dogs and cats were prospectively analyzed with possible influencing factors (gender, ASA classification, underlying endocrinological diseases, duration of anesthesia, duration of surgery, type of surgery, perioperative antibiotic prophylaxis (POA), duration of hospitalization) affecting the infection rate. After surgery all cases were followed up either 30 or 90 days, if implants were used. The effect of the various factors was evaluated using multivariable logistic regression analysis. SSI was detected in 25/664 clean and 10/143 clean-contaminated surgeries. Longer hospitalization, without antimicrobial prophylaxis, and male animals had a significantly higher risk of SSI. In clean surgeries, SSI occurred in 2,3 % of all cases with POA and 5,3 % without POA. The SSI in clean-contaminated was 3,6 % with POA and 9 % without. This difference resulted mainly from the results of osteosynthesis, gastrointestinal and skin surgeries. However, other types of surgeries, such as castrations, neurological interventions, abdominal and thoracic surgeries, and surgeries in the head and neck region, showed comparable infection rates with and without POA.

INTRODUCTION: Toute intervention chirurgicale comporte un risque d'infection postopératoire (infection du site opératoire = ISO). Ce risque d'infection peut être influencé par différents facteurs, dont l'antibioprophylaxie périopératoire. En termes de gestion responsable des antibiotiques, les antibiotiques ne devraient être utilisés que s'il existe un avantage prouvé pour le patient. Cependant, cet avantage n'a pas encore été prouvé de manière concluante, en particulier pour les chirurgies propres et propres-contaminées. L'objectif de notre étude était de documenter divers facteurs d'influence pertinents sur le taux d'infection après des chirurgies propres et propres-contaminées chez les chiens et les chats. Nous avons en particulier cherché à savoir dans quelle mesure une utilisation réduite des antibiotiques affecte le taux d'infection en tenant compte de tous les facteurs d'influence. Sur une période de onze mois, 807 chirurgies propres et contaminées chez des chiens et des chats ont été analysées prospectivement avec les facteurs d'influence possibles (sexe, classification ASA, maladies endocrinologiques sous-jacentes, durée de l'anesthésie, durée de la chirurgie, type de chirurgie, prophylaxie antibiotique périopératoire (POA), durée de l'hospitalisation) affectant le taux d'infection. Après la chirurgie, tous les cas ont été suivis durant soit 30 soit90 jours si des implants avaient été utilisés. L'effet des différents facteurs a été évalué par une analyse de régression logistique multivariable. Des ISO ont été détectées dans 25/664 chirurgies propres et 10/143 chirurgies contaminées propres. Une hospitalisation plus longue sans prophylaxie antimicrobienne ainsi que les animaux mâles présentaient un risque significativement plus élevé d'ISO. Dans les chirurgies propres, les ISO sont survenues dans 2,3 % des cas avec POA et 5,3 % sans POA. Dans les opérations propres-contaminées, les ISO étaient de 3,6 % avec POA et de 9 % sans POA. Cette différence était principalement due aux résultats des ostéosynthèses, des chirurgies gastro-intestinales et cutanées. En revanbche, d'autres types de chirurgies, comme les castrations, les interventions neurologiques, les chirurgies abdominales et thoraciques et les chirurgies de la tête et du cou ont montré des taux d'infection comparables avec et sans POA.

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.

Benefits of cyanoacrylate mesh closure following exploratory laparotomy in horses.

BACKGROUND: Skin closure of laparotomy incisions using topical 2-octyl cyanoacrylate (2-OCA) mesh provides a secure bactericidal barrier in humans, which may reduce the risk of postoperative incisional complications. However, the benefits of using this mesh have not been objectively assessed in horses. METHODS: From 2009 to 2020, three methods of skin closure were used following laparotomy for acute colic, including metallic staples (MS), suture (ST) and cyanoacrylate mesh (DP). The closure method was not randomised. Owners were contacted 3 months or more after the surgery to record any postoperative complications that occurred. For each method of closure, the rates of surgical site infection (SSI) and herniation were recorded, as well as surgical time and treatment costs, including those for incisional complications. Chi-square testing and logistic regression modelling were used to assess differences between the groups. RESULTS: A total of 110 horses were recruited (45 in the DP group, 49 in the MS group and 16 in the ST group) The overall rate of SSI was 15.5%, with rates of 8.9%, 18.4% and 25% for the DP, MS and ST groups, respectively (p = 0.23). In addition, incisional hernias developed in 21.8% of cases, with 8.9%, 34.7% and 18.8% of horses in the DP, MS and ST groups, respectively, being affected (p = 0.009). The median total treatment cost did not differ significantly between groups (p = 0.47). LIMITATION: This was a retrospective study with non-randomised choice of closure method. CONCLUSIONS: No significant differences in the rate of SSI or overall cost wwere demonstrated between treatment groups. However, MS was associated with a higher rate of hernia formation than DP or ST. Despite increased capital cost, 2-OCA proved to be a safe skin closure method in horses and was no more expensive than DP or ST by the time visits to remove sutures/staples and treat infections were factored in.