Trends in companion animal access to veterinary care in Canada, 2007 to 2020.

Objective: Assess trends in access to veterinary care for companion animals in Canada. Procedure: Analysis and integration of available data, 2007 to 2020. Results: Cumulative growth in the Canadian veterinary workforce was 38%, and 49% for companion animal veterinarians. Clients per companion animal veterinarian decreased 30% from 2008 to 2020. Absolute client numbers increased 1.3%, compared to pet population growth of 17%. Medicalized pets (those that had received veterinary care in the past year) increased 25%, from 9.02 million in 2007 to 11.24 million in 2020. Non-medicalized pets increased 1.8%, from 4.48 million to 4.56 million. In 2007, 33% of pets were non-medicalized, compared to 29% (15% of dogs and 42% of cats) in 2020. There was a cumulative increase of 31% for total non-medicalized dogs, and a change of -5.6% for cats. Gross and net revenues per client increased by 99 and 112%, respectively, compared to cumulative inflation of 21%. Conclusion and clinical relevance: The analysis identified a large cohort of pets that had not received veterinary care each year. The trends were fewer clients per veterinarian, each paying higher veterinary costs, and suggested a relative, rather than absolute, veterinary capacity shortage overall. Accessible care-provision models must be encouraged, regulated for, and allowed to flourish alongside traditional models.

Tendances en matière d'accès des animaux de compagnie aux soins vétérinaires au Canada, 2007 à 2020. Objectif: Évaluer les tendances en matière d'accès aux soins vétérinaires pour les animaux de compagnie au Canada. Procédure: Analyse et intégration des données disponibles, 2007 à 2020. Résultats: La croissance cumulative de la main-d'œuvre vétérinaire canadienne était de 38 %, et de 49 % pour les médecins vétérinaires d'animaux de compagnie. Le nombre de clients par vétérinaire pour animaux de compagnie a diminué de 30 % entre 2008 et 2020. Le nombre absolu de clients a augmenté de 1,3 %, comparé à une croissance de la population d'animaux de compagnie de 17 %. Les animaux de compagnie médicalisés (ceux qui ont reçu des soins vétérinaires au cours de l'année écoulée) ont augmenté de 25 %, passant de 9,02 millions en 2007 à 11,24 millions en 2020. Les animaux de compagnie non médicalisés ont augmenté de 1,8 %, passant de 4,48 millions à 4,56 millions. En 2007, 33 % des animaux de compagnie étaient non médicalisés, contre 29 % (15 % des chiens et 42 % des chats) en 2020. Il y a eu une augmentation cumulée de 31 % pour le total des chiens non médicalisés, et une variation de ­5,6 % pour les chats. Les revenus bruts et nets par client ont augmenté respectivement de 99 et 112 %, par rapport à une inflation cumulée de 21 %. Conclusion et pertinence clinique: L'analyse a identifié chaque année une large cohorte d'animaux de compagnie qui n'avaient pas reçu de soins vétérinaires. Les tendances étaient moins de clients par vétérinaire, chacun payant des frais vétérinaires plus élevés, et suggéraient une pénurie globale de capacité vétérinaire relative plutôt qu'absolue. Les modèles de prestation de soins accessibles doivent être encouragés, réglementés et autorisés à prospérer aux côtés des modèles traditionnels.(Traduit par Dr Serge Messier).

Minimizing the Risk of Surgical Site Infection Following Hip Fracture Operation.

Introduction: Hip fractures are the most common serious injury in the elderly, associated with disability, morbidity, and mortality. Surgical site infection (SSI) is a serious post-operative complication. This prospective cohort study outlines how our center made cumulative improvements in SSI incidence rates, reaching a 12-month average of 0.5%. Methods: All patients undergoing hip fracture operation between 2016 and 2021 were included. The primary outcome measure was confirmed SSI, according to the Public Health England definition. Results were compared with the baseline recordings by an independent SSI team in 2013. Demographic data were compared with National Hip Fracture Database records. Peri-operative infection control and wound management tactics introduced between 2014 and 2021 were collated to gain an overview care bundle. Results: Baseline recordings identified a 9.0% SSI rate in a three-month observation period. In our study, 3,138 hip fracture operative cases were completed between October 2016 and December 2021. There were 9 superficial and 32 deep infections identified, yielding an overall infection rate of 1.3%. However, when analyzing the 12-month average, there was consistent decline in SSI from the baseline 9.0% in 2013 to 0.5% in 2021 (p < 0.05). A peri-operative care bundle included pre-operative bleeding risk assessment. Intra-operatively, double preparation and draping is used for arthroplasty. Broad-spectrum antibiotic agents and tranexamic acid are administered. Meticulous hemostasis and watertight wound closure are observed. Anti-coagulated patients received negative pressure dressings. Post-operatively, a dedicated senior lead team provided daily inpatient review of patients, with urgent consultant review of all wound healing concerns. Conclusion: Patients with a hip fracture have numerous risk factors for SSI. A dedicated multi-focal tactic, adopted by a multi-disciplinary department, can yield substantial risk reduction. Each intervention is evidence based and contributes to cumulative improvement. By prioritizing infection prevention, we have minimized the need for complex infection management interventions and achieved an annual saving of £860,000 for our trust.