Retrospective analysis of postoperative complications following surgical treatment of ileal impaction in horses managed with manual decompression compared to jejunal enterotomy

To determine factors associated with development of postoperative ileus (POI) in horses undergoing surgery for colic. Prospective case-control study. 251 horses undergoing colic surgery, of which 47 developed POI. Signalment, history, clinicopathologic data, pre- and postoperative treatments, lesions, complications, costs, and outcome were recorded for all horses during hospitalization. Variables associated with increased odds of POI included small intestinal lesion, high PCV, and increased duration of anesthesia. There was modest evidence that pelvic flexure enterotomy and intraoperative administration of lidocaine may have reduced the odds of developing POI. Findings during the preoperative and intraoperative periods can be used to identify horses at increased risk of POI. Reducing surgical and anesthetic duration should decrease the incidence of POI.

To determine risk factors associated with development of postoperative ileus in horses undergoing surgery for colic.

Colic surgery is a frequently performed operation with high postoperative mortality. This study was undertaken to identify variables associated with decreased postoperative survival. We used data from 321 horse years of postoperative survival time to model the probability of survival following recovery from colic surgery. Continuous variables were modelled using a 6 variable, penalised Cox regression model. This demonstrated approximately linear relationships between survival and the following variables: increase in packed cell volume (PCV), intestinal resection length, time to surgery (interval between onset of colic and surgery) and duration of surgery. No significant decrease in survival was demonstrated with increasing age of the patient or with heart rate. The only categorical variable to be significantly associated with decreased survival was epiploic foramen entrapment. The final, fixed effects Cox proportional hazards model of postoperative survival included the variables epiploic foramen entrapment, PCV, resection length and duration of surgery, each variable adjusted for the nonlinear relationship with time to surgery. Residual variation in postoperative survival attributable to professional personnel (referring veterinary surgeon, anaesthetist and surgeon) was explored by fitting each as a random effects term in the model. Little of the residual variation could be attributed to any category of personnel. Model diagnostics indicated little influence by individual outliers on model parameters and little evidence of subjects poorly predicted by the final model. The study highlights factors influencing the long-term survival of horses recovering from colic surgery and proposes a model that can be used to inform prognosis.