A multicenter retrospective case-cohort study on the prevalence of incisional morbidities in late pregnant mares following exploratory celiotomy (2014-2019): 579 cases.

OBJECTIVE: To report the prevalence and risk factors for incisional morbidities in late pregnant and nonpregnant/early pregnant control mares following colic surgery. DESIGN: Multicenter, retrospective, cohort study from January 2014 to December 2019. SETTING: Two university teaching hospitals and 1 private referral center. ANIMALS: Five hundred and seventy-nine fillies and mares ≥2 years old that underwent celiotomy. Pregnant mares (n = 54) were >240 days in gestation from the last known breeding date and were compared to control females (n = 525) undergoing colic surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Morbidity rates were not different between mare groups with 56% of pregnant mares and 51% of control mares reporting at least 1 morbidity. Incisional swelling was the most common reported complication in both groups. Incisional swelling was associated with shorter hospital stays (odds ratio [OR], 0.18; P < 0.01), and drainage was associated with a longer hospital stay (OR, 1.27; P ≤ 0.01) and with use of an abdominal bandage (OR, 4.4; P < 0.01). Herniation was associated with hypercapnia under anesthesia (OR, 1.1; P = 0.048), previous abdominal surgery (OR, 8.3; P = 0.003), and with use of an abdominal bandage (OR, 56; P = 0.006). Body wall dehiscence was associated with longer hospital stay (OR, 1.2; P < 0.01). Nonsurvival was higher in pregnant mares (13%) compared to control mares (5%; P = 0.02). CONCLUSIONS: The prevalence of incisional morbidities did not differ between pregnant and control mares undergoing colic surgery. Several factors were associated with incisional morbidities, including the duration of surgery and anesthesia, anesthetic variables, abdominal bandage use, previous ventral abdominal incision, and longer duration of hospitalization.

Prognosis for survival to discharge and racing performance in Thoroughbred foals treated for single joint septic arthritis (2009-2016).

BACKGROUND: Haematogenous septic arthritis is a major cause of morbidity and mortality in foals. Previous research has demonstrated a variable prognosis for athletic performance in foals diagnosed with septic arthritis. OBJECTIVE: To determine the racing prognosis for Thoroughbred foals, 6 months of age or less with single septic joint of presumed haematogenous origin without recognised systemic sepsis or other serious comorbidity compared with a group of maternal sibling controls. STUDY DESIGN: Retrospective cohort study. METHODS: Data were collected from Rood and Riddle Equine Hospital in-patient records from 2009 to 2016. Parameters evaluated included: diagnostic tests, therapeutic regimens, final diagnosis and outcome. Racing records were obtained from a public archive for cases and two maternal siblings. Univariable analyses of categorical variables were conducted. RESULTS: Ninety-five cases of Thoroughbred foals 6 months of age or less were included in this study. The last measured synovial cell count prior to hospital discharge or euthanasia (OR 0.5, p value 0.002, 95% CI: 0.3-0.8) was an indicator of poor prognosis for survival to discharge. Overall, the prognosis for survival was high (93%). Total winnings per career were the only statistically significant racing performance variable between cases and paired controls (IRR 0.7, p value, 0.05, 95% CI: 0.5-0.99). MAIN LIMITATIONS: Retrospective study, evaluation of one regional population, potential for unknown prior exclusionary treatment on farm, unknown chronicity, no data on acute phase proteins and proportion of neutrophils of synovial fluid and unknown medical records of controls. CONCLUSIONS: While total winnings were reduced compared with maternal siblings, Thoroughbred foals with single joint septic arthritis have a favourable prognosis for both survival and starting in a race.

CONTEXTO: Artrite séptica hematogênica é a maior causa de morbidade e mortalidade em potros. Estudos prévios demonstraram um prognóstico variável para a performance atlética de potros diagnosticados com artrite séptica. OBJETIVOS: Determinar o prognóstico atlético de potros Puro Sangue Inglês, de seis meses de idade ou menos, com uma única articulação séptica de origem presumida hematogênica, sem nenhum sinal sistêmico de sepse reconhecido e sem outras comorbidades sérias, comparados com um grupo de irmãos maternos como controle. DELINEAMENTO DO ESTUDO: Estudo coort retrospectivo. MÉTODOS: Dados foram coletados de pacientes do Rood and Riddle Equine Hospital de 2009 a 2016. Os parâmetros avaliados incluíram: testes diagnósticos, tratamentos, diagnóstico final e sobrevivência à alta hospitalar. Os dados das corridas foram obtidos do equibase.com para os casos clínicos e dois irmãos maternos. Análise univariável de variantes categóricas foi realizada. RESULTADOS: Noventa e cinco potros Puro Sangue Inglês de seis meses de idade ou menos foram incluídos nesse estudo. A última mensuração da contagem de células no líquido sinovial antes da alta hospitalar ou eutanásia (OR 0.5, p-value 0.002, 95% CI: 0.3 a 0.8) foi um indicador estatisticamente significante de prognóstico ruim para sobrevivência. O prognóstico para sobrevivência foi alto (93%). O ganho total por carreira foi o único fator estatisticamente diferente entre casos e controles (IRR 0.7, p-value, 0.05, 95% CI: 0.5 a 0.99). PRINCIPAIS LIMITAÇÕES: Estudo retrospectivo, avaliação de uma população em uma única região, chances de um tratamento desconhecido na fazenda, cronicidade desconhecida, ausência de resultados de proteínas de fase aguda e concentração de neutrófilos no líquido sinovial, e ausência de controles dos registros médicos. CONCLUSÕES: Apesar do ganho total ser menor quando comparado com os irmãos maternos, potros Puro Sangue Inglês com uma única articulação séptica têm um prognóstico favorável para sobrevivência e para iniciar uma corrida.

Preoperative computed tomographic evaluation of neonatal foals with rib fractures.

OBJECTIVE: To compare ultrasonographic and computed tomographic findings in neonatal foals prior to surgical repair of rib fractures as well as postoperative outcomes in foals with and without preoperative thoracic computed tomography (CT). Study design Retrospective cohort study. Sample population 43 neonatal foals undergoing surgical treatment of rib fractures between 2013 and 2021. METHODS: Medical records were reviewed for age, sex, delivery method, comorbidities, presurgical anesthetic time, surgical time, number and location of fractured ribs identified with ultrasound and CT, number and location of ribs surgically repaired, survival to discharge, and post-mortem findings. Statistical analyses were performed using chi-square, Fisher's exact, and t-tests. RESULTS: Twenty-two foals underwent surgical repair of rib fractures after preoperative CT from 2019-2021 (median: 4/18/20) and 21 foals were anesthetized (20 underwent repair) for surgical repair of rib fractures without preoperative CT from 2013-2020 (median: 4/9/15). Ultrasound and CT findings differed in number and location of fractured ribs in 13/17 (76%) foals (p = .049). More cranially positioned ribs were identified as fractured with CT than with ultrasonography (p = .035). Survival to discharge was improved when foals underwent CT (20/22, 91%) than when they did not (12/20, 60%, p = .019). CONCLUSION: Ultrasound findings differed from CT findings in most foals. Foals evaluated with CT were more likely to survive to hospital discharge. CLINICAL SIGNIFICANCE: When available, CT is recommended prior to surgical repair of rib fractures in neonatal foals.

Comparative results of 3 treatments for medial femoral condyle subchondral cystic lesions in Thoroughbred racehorses.

OBJECTIVES: To compare 3 different methods for treatment of medial femoral condyle (MFC) subchondral cystic lesions in Thoroughbred horses <24 months old based on the criterion of ability to race post-treatment. STUDY DESIGN: Retrospective cohort study. ANIMALS: Thoroughbreds (n = 107, age < 24 months) diagnosed with MFC subchondral cystic lesions. METHODS: Medical records between January 2004 and December 2017 were reviewed. Three treatment methods were used in these horses during that time frame: arthroscopic debridement, intralesional autologous mesenchymal stem cell (MSC) injection, and intralesional corticosteroid injection. The outcome evaluated was the ability to compete in a pari-mutuel race. RESULTS: Seventy-eight of 107 Thoroughbreds (73%) raced post-treatment; 41/57 (72%) of horses treated by arthroscopic debridement raced; 16/19 (84%) of horses treated with intralesional MSCs raced; 21/31 (68%) of horses treated with intralesional corticosteroids raced. There was no difference between groups in the ability to start a race. Sex, limb affected, and lesion size also had no effect on the ability to start a race. There was a trend for increasing lesion size reducing the probability of racing. CONCLUSIONS: Seventy-three percent of the horses raced, but there was no difference in the ability of unraced Thoroughbreds to race after treatment of MFC subchondral cystic lesions with arthroscopic debridement, intralesional mesenchymal stem cells, or intralesional corticosteroids. CLINICAL SIGNIFICANCE: The 3 reported treatment options may be considered for treatment of MFC subchondral cystic lesions with a good prognosis for racing post-treatment. Owners should be advised that increasing lesion size decreases the probability of racing.

The impact of grade of laryngeal function immediately prior to laryngoplasty and ipsilateral ventriculocordectomy on postoperative performance: 623 Thoroughbred racehorses (1998-2013).

BACKGROUND: There is persistent concern among some trainers, owners and veterinarians regarding the effect of preoperative laryngeal function grade on the outcome of laryngoplasty and ventriculocordectomy (LPVC). OBJECTIVES: To determine the effect of laryngeal function grade prior to LPVC on postoperative performance. STUDY DESIGN: Retrospective case-series. METHODS: Medical and race records of Thoroughbred racehorses diagnosed with recurrent laryngeal neuropathy (RLN) and treated with LPVC between 1998 and 2013 were reviewed. Horses were placed into three groups based on preoperative laryngeal function grade (grade III.1, grades III.2/III.3, and grade IV). The effect of preoperative laryngeal function grade on postoperative performance was determined by multivariable logistic regression, Cox proportional hazard model and multivariable linear regression analysis. RESULTS: In a multivariable logistic regression, grade III.2/III.3 horses had 1.88 times higher odds (95% CI = 1.03-3.43) of racing after LPVC than grade IV (P = .04). A multivariable Cox's proportional hazard analysis controlling for race prior to surgery (P < .01) showed that likelihood of racing postoperatively was not different between grade III.1 and grade IV (P = .6), and although not statistically significant, there was a tendency for grades III.2/III.3 to be more likely to race postoperatively than horses with grade IV (P = .07). Kaplan-Meier survival analysis showed that grade IV horses took a longer time to race compared with grade III.1 and grade III.2/III.3. Laryngeal function grade did not influence the mean earnings per start. MAIN LIMITATIONS: The small number of horses in the grade III.1 group compared with the III.2/III.3 and IV groups influenced the effect of grade III.1 on outcome. CONCLUSIONS: Laryngeal function grade may affect likelihood of racing after LPVC, but not earnings per start. Grade III. 2/III.3 horses were more likely to race postoperatively than grade IV horses, and grade IV horses took a longer time to first race after LPVC.

End-to-Side Versus Side-to-Side Jejunocecostomy in Horses: A Retrospective Analysis of 150 Cases.

OBJECTIVES: To determine factors associated with postoperative reflux, postoperative colic, repeat celiotomy, and survival in horses after end-to-side (E2S) or side-to-side (S2S) jejunocecostomy. STUDY DESIGN: Retrospective, multicenter study. SAMPLE POPULATION: Horses (n = 150). METHODS: Admissions, intra- and postoperative data were collected from medical records of horses that had E2S or S2S jejunocecostomy. Descriptive statistics were calculated and data were analyzed using parametric and nonparametric tests, linear and multivariate logistic regression with significance set at P < .05. Kaplan-Meier estimate of the survival function was performed. RESULTS: One hundred fifty horses (S2S = 90, E2S = 60) were included. S2S procedures were performed using staples (n = 57) or hand-sewn (33). Method of anastomosis was not significantly associated with development of postoperative reflux or colic, repeat celiotomy, whether the horse was alive at hospital discharge or 12 months after discharge. The number of years that the principal surgeon was boarded by the American College of Veterinary Surgeons significantly affected whether the horse was discharged from the hospital alive (P = .003). Age (P = .006) was significantly associated with 12-month survival. Increased age (P = .013) and administration of prokinetic medication (P = .0006) were significantly associated with development of postoperative reflux. Sixty-eight (76%) horses with S2S and 52 (87%) horses with E2S were discharged alive. CONCLUSION: Age, patient related variables, and surgeon experience may influence morbidity and mortality more than method of jejunocecostomy.

Evaluation of survival rate and athletic ability after nonsurgical or surgical treatment of cleft palate in horses: 55 cases (1986-2008).

OBJECTIVE: To determine survival rate and athletic ability after nonsurgical or surgical treatment of cleft palate in horses. DESIGN: Retrospective case series. ANIMALS: 55 horses with cleft palate. PROCEDURES: 13 of the 55 horses died or were euthanized without treatment and were not included in all analyses. Medical records were reviewed for signalment, history, method of diagnosis, soft or hard palate involvement, type of surgical procedure performed, postoperative complications, and survival to hospital discharge. Information on athletic ability was acquired from race records and follow-up conversations with owners, trainers, or referring veterinarians. RESULTS: The predominant reason for initial evaluation was milk or feed in the nostrils (60%). The diagnosis was confirmed by means of videoendoscopy of the upper portion of the airway in all cases. Most cases involved the soft palate only (92.7%). Twenty-six of the 55 (47.3%) horses underwent surgical repair, and 12 of these had dehiscence at the caudal edge of the soft palate. Among potential racehorses, 14 of 33 had surgery. Of these, 12 of 14 survived to discharge and 2 horses raced. Among potential racehorses, 10 of 33 were discharged without surgery and 2 of these raced. Among nonracehorses, 12 of 22 underwent surgery and 11 survived to discharge. All horses that were discharged and for which follow-up information was available survived to 2 years of age or older without ill thrift despite dehiscence at the caudal edge of the soft palate and continued mild nasal discharge. CONCLUSIONS AND CLINICAL RELEVANCE: Horses with cleft palate had a higher survival rate than previously reported.

Survival rates of mares and foals and postoperative complications and fertility of mares after cesarean section: 95 cases (1986-2000).

OBJECTIVE: To assess survival-to-discharge rates of mares and foals and postoperative complications and fertility in mares following cesarean section (C-section). DESIGN: Retrospective case series. ANIMALS: 95 mares. PROCEDURES: Medical and breeding records of mares that underwent C-section were reviewed; signalment, surgical technique, complications, survival-to-discharge rate, and pregnancy and foaling rates were recorded and evaluated. Foaling rates in the 3 years after C-section were compared with the cumulative foaling rate before C-section. RESULTS: C-section was performed because of dystocia (n = 71) or concurrent maternal disease (20) or was elective (4). Overall survival-to-discharge rate was 84% (80/95) for mares and 35% (28/80) for foals. Six of 15 mares that had partial fetotomies prior to C-section did not survive. Mares that had dystocia for < 90 minutes had the fewest complications. Cumulative foaling rate before C-section was 77% (394/509). Overall foaling rate for the 3 years after C-section was 52% (30/58) and 68% (13/19) when duration of dystocia was ≥ 90 minutes and < 90 minutes, respectively, and was 31 % (9/29) for mares ≥ 16 years old. Foaling rate was significantly lower for mares bred in the same year as C-section than for mares bred in later years. CONCLUSIONS AND CLINICAL RELEVANCE: Breeding in the same year as C-section, dystocia for ≥ 90 minutes before C-section, and mare age ≥ 16 years were associated with poor foaling rates. Prognosis for delivery of a live foal in years following C-section was good if duration of dystocia was < 90 minutes and the mare was < 16 years old at the time of surgery.

Resection and anastomosis of the descending colon in 43 horses.

OBJECTIVES: To determine (1) the short- (to hospital discharge) and long- (>6 months) term survival, (2) factors associated with short-term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. STUDY DESIGN: Multicentered case series. ANIMALS: Horses (n=43) that had descending colon resection and anastomosis. METHODS: Medical records (January 1995-June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and clinicopathologic examinations, surgical findings, postsurgical treatment and complications, and short-term survival (hospital discharge). Long-term survival was defined as survival > or =6 months after hospital discharge. RESULTS: Of 43 horses, 36 (84%) were discharged from the hospital. Twenty-eight of 30 horses with follow-up information survived > or =6 months. No significant associations between perioperative factors and short-term survival were identified. Lesions included strangulating lipoma (n=27), postfoaling trauma (4), infarction (4), intraluminal obstruction (2), and other (6). Common postoperative complications included fever and diarrhea. During hospitalization 7 horses were euthanatized or died because of septic peritonitis (3), endotoxemia (3), and colic and ileus (1). CONCLUSIONS: Descending colon resection and anastomosis has a favorable prognosis for hospital discharge and survival > or =6 months. The most common cause of small colon incarceration was strangulating lipoma. CLINICAL RELEVANCE: Complications include postoperative fever and diarrhea but the prognosis is good after small colon resection and anastomosis.

Endoscopic evaluation of arytenoid function and epiglottic structure in Thoroughbred yearlings and association with racing performance at two to four years of age: 2,954 cases (1998-2001).

OBJECTIVE-To determine the association between results of endoscopic evaluation of arytenoid function (AF) and epiglottic structure (ES) in Thoroughbred yearlings and racing performance at 2 to 4 years of age. DESIGN-Retrospective case series. ANIMALS-2,954 Thoroughbred yearlings. Procedures-Records of yearlings that had endoscopic evaluation of the larynx between 1998 and 2001 were obtained, and results were graded by use of standardized scales. A modified Havemeyer scale (grade I, II.1, II.2, III, or IV) was used to evaluate AF; ES was graded on a scale of 0 to IV. Records were annotated if the epiglottis was subjectively short or narrow. Racing performance data were obtained from an online database. RESULTS-Horses with grade II.2 AF had significantly less earnings at 4 years of age, compared with earnings of horses with AF grades < II.2. Grade III AF was associated with fewer starts and less earnings at 3 and 4 years of age. No horses met the criteria for grade IV AF. Horses with ES grades > II had less earnings at 2 and 4 years of age, compared with earnings of horses with ES grades < II. A short epiglottis was associated with less earnings at 2 and 3 years of age. CONCLUSIONS AND CLINICAL RELEVANCE-Analysis suggested that yearlings with grade III AF had a decrease in athletic potential. Yearlings with grade II.2 AF, an ES grade > II, or a short epiglottis typically had decreases in racing performance. These factors should be evaluated carefully when developing purchase recommendations.

Surgical treatment of gastric outflow obstruction in 40 foals.

OBJECTIVE: To report short- and long-term survival and factors affecting outcome of foals after surgical correction of gastric outflow obstruction. STUDY DESIGN: Case series. ANIMALS: Foals (n=40) aged 5-180 days. METHODS: Clinical signs, laboratory data, diagnostic imaging, surgical findings, surgical procedures, medical treatment, and necropsy findings were retrieved from medical records. Outcome was obtained by reviewing performance, sales, and produce records or by telephone conversations with the owners. RESULTS: Gastric outflow obstruction was treated by gastroduodenostomy or by gastrojejunostomy with or without jejunojejunostomy. Long-term follow-up was available for 36 of 39 foals that survived to hospital discharge; 25 (69%) survived >2 years. All 8 foals with pyloric obstruction survived >2 years, whereas only 11 of 21 (52%) foals with duodenal obstruction survived >2 years. Six of 8 foals with obstruction of the duodenum and pylorus survived >2 years. Obstruction of the duodenum, adhesions to the duodenum, and postoperative ileus were significantly associated with decreased long-term survival. CONCLUSIONS: Long-term outcome after gastric bypass procedures was substantially improved compared with previous reports. Factors that may have contributed to improved survival include better case selection and performing the gastrojejunostomy with the jejunum aligned from left to right. CLINICAL RELEVANCE: The prognosis for long-term survival after surgical bypass of pyloric obstruction is excellent. The overall prognosis for long-term survival after surgical bypass of duodenal obstruction is fair but should be considered guarded in those with pre-existing duodenal adhesions.

Selected urogenital surgery concerns and complications.

This article discusses selected urogenital surgeries. The discussion focuses on perioperative concerns and complications. The ideal approach to addressing complications resulting from disease processes or surgery is to avoid them. This approach requires knowledge of what can go wrong, gained by personal experience and that shared by others. The better one is able to anticipate potential complications, the more likely complications can be avoided.

Sternothyroideus myotomy, staphylectomy, and oral caudal soft palate photothermoplasty for treatment of dorsal displacement of the soft palate in 102 thoroughbred racehorses.

OBJECTIVE: To compare racing performance before and after sternothyroideus myotomy, staphylectomy, and oral caudal soft palate photothermoplasty in Thoroughbred racehorses with intermittent dorsal displacement of the soft palate (DDSP). STUDY DESIGN: Retrospective study. ANIMALS: Thoroughbred racehorses (n=102) with DDSP. METHODS: Retrieved data included signalment, primary complaint, and upper respiratory tract endoscopic finding. Lifetime race records were compared for earnings per start before and after surgery, days to 1st start, and races won postoperatively. RESULTS: Comparing mean earnings per start for 3 races before (2792 dollars) and after (3806 dollars) surgery, racing performance improved significantly after surgery in 63% (46/73) of horses that competed in at least 1 race before and after surgery (P=.02). Mean and median days to 1st start after surgery were 109 and 69 days, respectively. Of horses that raced postoperatively 65% (60/92) won at least 1 race, and 77% (71/92) raced in >5 races after surgery. CONCLUSIONS: Sternothyroideus myotomy, staphylectomy, and oral caudal soft palate photothermoplasty significantly improved racing performance in experienced Thoroughbred racehorses with performance limiting DDSP, and overall had a similar outcome to other reported surgical techniques for treatment of DDSP. Clinical Relevance-Sternothyroideus myotomy, staphylectomy, and oral caudal soft palate photothermoplasty should be considered as a surgical approach to correction of DDSP in Thoroughbred racehorses; however, it is possible that staphylectomy may not be necessary to achieve a desirable outcome.