Investigating the effect of anxiety on pain scores in dogs.

OBJECTIVE: To investigate the relationship between anxiety and pain scores using the Glasgow Composite Measure Pain Scale-Short Form (CMPS-SF) in dogs. STUDY: Prospective observational study. ANIMALS: A group of 18 dogs undergoing surgical management of stifle disease. METHODS: Preoperatively dogs were scored using the CMPS-SF, the anxiety behaviour-based Reactivity Evaluation Form (REF), a Visual Analogue Scale (VAS) for anxiety and a sedation score. Assessments of pain, anxiety and sedation were repeated approximately 2-6 hours postoperatively. Dogs were divided into groups based on preoperative REF ('Low REF' and 'High REF'), and VAS scores ('Low VAS' and 'High VAS'). Scores (CMPS-SF, REF, VAS and sedation) were compared between groups using Mann-Whitney U tests. Preoperative and postoperative CMPS-SF, REF and VAS scores were compared using Wilcoxon signed-rank tests. Relationships between anxiety and CMPS-SF scores were assessed using a Spearman rank correlation coefficient. Scores are presented as median (range). A p value of < 0.05 was considered significant. RESULTS: When divided based on REF, CMPS-SF scores did not differ between groups preoperatively [Low REF: 2 (0-3), High REF: 2 (1-3); p = 0.509] or postoperatively [Low REF: 3 (2-5), High REF: 3 (2-5); p = 0.624]. When divided based on VAS, CMPS-SF scores did not differ between groups preoperatively [Low VAS: 2 (0-2), High VAS: 2 (1-3); p = 0.215] or postoperatively [Low VAS: 3 (2-5), High VAS: 3 (2-5); p = 1]. Postoperative REF [pre: 4.5 (2-8), post: 5 (4-10); p = 0.0105] and CMPS-SF scores [pre: 2 (0-3), post: 3 (2-5); p = 0.0318] increased significantly compared with preoperative scores. CONCLUSIONS AND CLINICAL RELEVANCE: No apparent relationship exists between baseline anxiety levels and CMPS-SF scores. Understanding the influence of anxiety when using the CMPS-SF is important when assessing pain in dogs. Anxiety and pain may increase postoperatively in dogs undergoing orthopaedic surgery.

Economic Considerations on Costs and Pricing of Two Surgical Techniques for Treating Cranial Cruciate Disease in Dogs.

In surgical treatment of cranial cruciate ligament disease in dogs, Tibial Plateau Levelling Osteotomy (TPLO) and Tibial Tuberosity Advancement (TTA) are commonly established procedures and have proven effective in restoring limb function. Unlike clinical outcome, economic aspects have not been studied as extensively. However, the surgical intervention poses an enormous financial burden on patients' owners. In a veterinary practice setting, this study compares prices for TPLO and TTA and examines prices differences as well as potential cost drivers. Charges for veterinary treatments are based on the Gebührenordnung für Tierärztinnen und Tierärzte (GOT), which is mandatory for veterinarians in Germany but allows a certain range in billing. This study found that TPLO is charged at a higher price than TTA; however, this might not cover the additional costs of this procedure. The price is also associated with weight, heavier dogs being more expensive. The underlying strategies for pricing decisions may be based on costs, as efforts for TPLO and heavier dogs are higher in terms of a prolonged surgical time, the number of staff involved and in surgeons' training. Price setting may also be based on a quality promise, suggesting better clinical outcome in a more expensive procedure. Future investigations should involve economic considerations and consider cost-effectiveness analysis when evaluating surgical treatment options.

Surgical treatment of cranial cruciate ligament disease in dogs using Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement-A systematic review with a meta-analytic approach.

Tibial Plateau Leveling Osteotomy (TPLO) or Tibial Tuberosity Advancement (TTA) are commonly used surgical techniques for correction of cranial cruciate ligament (CCL) rupture in dogs. This systematic review aims to investigate whether one technique is superior to the other. Seventy-two studies on surgical management of CCL rupture have been identified and evaluated in regard of subjective and objective gait analysis criteria, development of osteoarthritis (OA), thigh circumference measurements, goniometry, joint stability, pain and complication rates. Almost half (47.2 %) of the studies were considered of low quality of evidence, leading to high heterogeneity in quality among studies; this posed a major limitation for an evidence-based systematic review of both surgical techniques. Out of 72 studies, there were only eleven blinded randomized clinical trials, of which five were rated with a low overall risk of bias. However, both techniques were considered to be successful management options. Subjective and objective gait analysis revealed no lameness at long-term evaluation for the majority of the patients. However, it appeared that TTA lead to better OA scores up to 6 months postoperatively, while TPLO had a lower rate of surgical site infections. In summary, no method can be clearly preferred, as most of the study evaluated were subpar. Studies with a high level of evidence are therefore urgently needed for such a common surgical procedure.

Risk factors for severe postoperative complications in dogs with cranial cruciate ligament disease - A survival analysis.

OBJECTIVE: To analyze the effect of surgical technique and other risk factors on severe postoperative complications in dogs with cranial cruciate ligament disease (CCLD). MATERIALS AND METHODS: A cohort study of 255 dogs (287 stifles) surgically treated for CCLD at two veterinary university hospitals (2011-2016) was performed. The electronic medical records were reviewed and dog owners and referring veterinarians contacted for additional information. The complications were classified as minor, major and catastrophic, where major and catastrophic were considered severe. A multivariable Cox proportional hazards model was applied to assess risk factors for severe postoperative complications. RESULTS: Three surgical techniques were used; lateral fabellotibial suture (LFS, 141 stifles), tibial plateau leveling osteotomy (TPLO, 77 stifles) and tibial tuberosity advancement (TTA, 69 stifles). The most common severe postoperative complications were surgical site infections or complications related to the surgical implant. Severe postoperative complications occurred in 31 % of the stifles treated with TPLO, 22 % of the stifles treated with LFS and 25 % of the stifles treated with TTA. The multivariable Cox proportional hazards model identified surgical technique (p = 0.0258) as a risk factor for severe postoperative complications; TPLO had a significantly lower hazard than LFS (hazard ratio (HR) = 0.37, p = 0.007) when controlling for body weight and age, which also were identified as risk factors (HR = 1.05, p < 0.001 and HR = 0.91, p = 0.047, respectively). CONCLUSION AND CLINICAL RELEVANCE: Although TPLO procedures had the highest occurrence of severe postoperative complications, the hazard was lower than for LFS after adjusting for body weight and age. This implies that it is important to consider potential effect-modifiers when comparing postoperative complications after CCLD surgery.

Postamputation Orthopedic Surgery in Canine Amputees: Owner Satisfaction and Outcome.

Surgical management of postamputation orthopedic disease (PAOD) in canine amputees has rarely been documented, and no reports describing outcome of stifle surgery in canine amputees are available. The objective of this multisite retrospective case series was to describe cases and evaluate satisfaction with and outcome of postamputation orthopedic surgery in canine amputees. Data was obtained through medical records and owner survey responses; data included signalment, amputation cause, diagnosis, surgical treatment, timeframes, and outcome assessment. Outcome was categorized as acceptable or unacceptable, and complications were classified as catastrophic, major, or minor. Eleven thoracic limb amputees and 6 pelvic limb amputees with surgically treated PAOD were identified. Surgically treated PAOD was reported at a median of 9.7 months (range 0.5-110 months) after amputation. All 17 amputees were treated for pelvic limb disease, predominantly for cranial cruciate ligament disease that occurred in 11 of 17 dogs. Major complications following orthopedic surgeries performed in 3 thoracic limb amputees consisted of infection (n = 2) and uncontrolled pain (n = 1). No major complications were reported following orthopedic surgeries performed in pelvic limb amputees. Acceptable mid-to-long-term outcome was achieved in 16 of the 17 canine amputees. Surgical treatment of pelvic limb disease did not appear to be associated with a high number of major complications in this case series. These findings suggest that orthopedic surgery, specifically stifle surgery, in canine amputees might be considered a feasible treatment option. Although there are inherent methodological limitations of retrospective studies and owner surveys, our case series provides new information that might help guide surgical treatment decisions in canine amputees suffering from orthopedic disease. Prospective studies using objective outcome measures evaluating surgical management of PAOD are necessary to confirm the provided information.

Estudo retrospectivo de cães com luxação patelar medial tratados cirurgicamente / Retrospective study of dogs with medial patellar luxation surgically treated

O trabalho teve por objetivo avaliar, por meio de estudo retrospectivo, a evolução de 48 cães de porte médio a toy com luxação patelar medial de desenvolvimento submetidos a procedimentos cirúrgicos corretivos. Dos membros com grau 1 (n=15), 46,7 por cento foram tratados apenas com a superposição do retináculo lateral, e 53,3 por cento, com a superposição do retináculo lateral e o aprofundamento do sulco troclear, não sendo detectadas complicações. Nos membros com grau 2 (n=35), as técnicas predominantes foram aprofundamento do sulco troclear e superposição do retináculo lateral (100 por cento dos casos), desmotomia medial (28,6 por cento) e sutura fabela-patela (2,8 por cento), com 14,3 por cento de recidiva da luxação. O período final de avaliação variou de três a nove meses, e sinais clínicos de claudicação ainda foram observados em 20 por cento dos membros. Em todos os casos de grau 3 (n=11), foram realizados aprofundamento do sulco troclear, superposição do retináculo lateral, liberação parcial do quadríceps, desmotomia medial e transposição lateral da crista da tíbia, que foi fixada com fio de Kirschner ou parafuso. Em 27,3 por cento dos membros, ocorreu reluxação e esses membros foram reoperados. Nesse grupo, foi detectada ausência de claudicação em 72,7 por cento dos membros. Nos membros com grau 4 (n=10), além das técnicas citadas para o grau 3, foi também necessária a ostectomia femoral em quatro membros. Houve reluxação em 30 por cento dos membros, que foram novamente operados. Embora 60 por cento dos membros tenham apresentado uma evolução positiva, ou seja, habilidade de apoio e locomoção com os membros após o período de avaliação de 5,2 meses, em geral, os cães adotavam uma postura com os membros pélvicos em flexão, em razão da inabilidade de estender totalmente o joelho. Com base nos dados obtidos, foi possível concluir que os procedimentos cirúrgicos adotados permitiram uma melhora da locomoção; porém, com exceção do grau...

The aim of this study was to evaluate retrospectively 48 medium to toy breed dogs with developmental medial patellar luxation submitted to corrective surgical procedures. In the grade 1 limbs, 46.7 percent were treated by lateral retinacular overlap and 53.3 percent by lateral retinacular overlap and deepening of the femoral groove with no complications. In the grade 2 limbs (n=35) were used the techniques of deepening of the femoral groove and lateral retinacular overlap (100 percent of the cases), medial desmotomy (28.6 percent), fabello-patellar sutures (2.8 percent) with 14.3 percent of reluxation. The last evaluation varied from 3 to 9 months, and clinical signs of lameness were still observed in 20 percent of the limbs. In all grade 3 cases (n=11) were performed deepening of the femoral groove, lateral retinacular overlap, partial quadriceps released, medial desmotomy and lateral transposition of the tibial tuberosiy that was fixated with Kirschner wire or screw. Reluxation occurred in 27.3 percent of the limbs that were reoperated. In this group 72.7 percent of the limbs had absence of lameness. In the grade 4 limbs (n=10) were used the same techniques of grade 3, but it was also necessary the femoral corrective osteotomy in 4 limbs. Reluxation was observed in 30 percent of the limbs that were reoperated. Although 60 percent of the limbs showed a positive evolution of the locomotion after 5.2 months of evaluation, in general the dogs showed a posture with the hind limbs in a semi-flexed position, due to the inability to fully extend the stifle. In conclusion, the surgical procedures used allowed an improvement of the locomotion, but except to grade 1, the patellar reluxation may occur in the other degrees suggesting the necessity of other protocols.