Article

Short-term wound complications and predictive variables for complication after limb amputation in dogs and cats

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Abstract

OBJECTIVES To identify short-term wound complications and associated predictive factors following amputation in dogs and cats.MATERIALS AND METHODS Retrospective review of case records of dogs and cats undergoing thoracic or pelvic limb amputation. Preoperative data on signalment, body weight, limb amputated, reason for amputation and laboratory parameters were collected. Details regarding surgical procedures and use of anaesthesia such as total surgical and anaesthesia times, incidences of intraoperative hypotension or hypothermia, method of muscle excision and type of skin closure utilized were recorded. Postoperative data on duration of hospital stay, use of postoperative antibiotics, use of a wound soaker catheter, wound complications noted both during hospitalization and at recheck and treatments if applicable were collected.RESULTSIn total, 67 records were identified including 39 dogs and 28 cats. Wound infection/inflammation complications occurred in 20.9% of cases and wound infection complications in 9%; 12.8% in dogs and 3.6% in cats. One (1.5%) complication was classified as major, which occurred immediately postoperatively. Nine (13.4%) minor complications occurred immediately after surgery and four (6.0%) were identified at recheck. Age was the only significant predictor of postoperative infection/inflammation following pelvic or thoracic limb amputation.CLINICAL SIGNIFICANCEShort-term wound complications following pelvic or thoracic limb amputation in cats and dogs were typically minor and resolved after treatment.

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... After limb amputation, substantial dead space might exist, and therefore seroma formation is not uncommon, especially in large breed dogs (Raske et al., 2015). A seroma develops due to the accumulation of a serohemorrhagic fluid, produced due to postoperative inflammation with bleeding and leakage from capillaries (Amsellem, 2011;Kilpadi and Cunningham, 2011). ...
... Besides seroma prevention, CIM with NPWT may also prevent surgical site infections (SSI) (Stannard et al., 2012;Horch, 2015;Suh et al., 2016). Factors that elicit SSI are surgical trauma to the soft tissues, excessive blood loss and substantial release of pain mediators, and/or long surgery time (Straw and Withrow, 1996;Kirby and Mazuski, 2009;Widgerow and Kalaria, 2012;Raske et al., 2015). Infections slow down the healing process, resulting in weak suture lines and an increased risk of wound dehiscence (Raske et al., 2015). ...
... Factors that elicit SSI are surgical trauma to the soft tissues, excessive blood loss and substantial release of pain mediators, and/or long surgery time (Straw and Withrow, 1996;Kirby and Mazuski, 2009;Widgerow and Kalaria, 2012;Raske et al., 2015). Infections slow down the healing process, resulting in weak suture lines and an increased risk of wound dehiscence (Raske et al., 2015). Closed incision NPWT may prevent SSI because tissue perfusion is enhanced, while environmental contamination of the wound is prohibited (Stannard et al., 2012;Horch, 2015;Suh et al., 2016). ...
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A four-year-old male castrated German shepherd dog was presented with severe left front leg lameness due to a fibrosarcoma lateral to the elbow. The ill-defined mass was not amendable to wide local excision and a curative-intent limb amputation was performed. Immediately post-operatively, closed incision management with negative pressure wound therapy (NPWT) was applied to minimize the risk of postoperative complications. The incision line was covered with a Prevena TM dressing attached to a NPWT pump set at a continuous negative pressure of-125 mmHg. The dressing was removed 72 hours later. No wound complications were evident and further healing was unremarkable.
... The amputation of a limb is a procedure commonly performed on small animals. The degree of adaptation, presence of risk factors associated with a poor quality of life, and owner satisfaction have been the topics of several veterinary studies during the past years (Withrow and Hirsch, 1979;Carberry and Harvey, 1987;Kirpensteijn et al., 1999;Dickerson et al., 2015;Raske et al., 2015;Galindo-Zamora et al., 2016). However, none of those studies have specifically addressed the occurrence of pain and pain-related behaviors after amputation that could account for PC. ...
... As previously described (Raske et al., 2015), postsurgical complications occurred in 20% of dogs and the most commonly reported was infection. No relations were found between the occurrence of pain after amputation and postoperative complications. ...
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The objective of this study was to describe the presence, prevalence, clinical manifestations, and risk factors of phantom complex and its effect on the quality of life for dogs that underwent amputation of a limb. An online questionnaire was developed containing 3 sections with a total of 69 questions. Clinical cases were recruited from a web site for 3-legged dog owners. Data were acquired from February to March 2015. Descriptive statistics and frequency distribution analyses were performed on the collected data. Chi-squared test or Fisher's exact test were used for assessment of the associations between categorical variables. One hundred seven questionnaires were completed by owners of dogs with limb amputation. The most frequent reason for amputation was related to neoplasia (54%). Pain after limb amputation was commonly experienced by dogs, and the time of onset and clinical manifestations of pain after limb amputation were found to resemble those of phantom complex. The duration of pre-amputation pain and time between diagnosis and amputation were identified as risk factors for a higher frequency of post-amputation pain episodes. This pilot study introduces previously unreported signs that may be interpreted as expressions of pain in amputee dogs.
... illness, and we will now turn to whether phenomenology can illuminate PC in non-human animals. Recent work by Menchetti et al. (2017) on PC in dogs is the first of its kind. While there has been prior work on the ability of small animals with amputated legs to adapt and the impact on their welfare (Kirpensteijn et al., 1999;Dickerson et al., 2015;Raske et al,. 2015), no work has focused on the question of whether they are able to experience phantom limbs. Menchetti et al. (2017) created a survey for dog owners in order to "identify signs and behaviors suggestive of neuropathic pain, evaluate risk factors associated with PC occurrence, and determine the owners' perceptions of the quality of life (Qo ...
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What is it like to be a bat? What is it like to be sick? These two questions are much closer to one another than has hitherto been acknowledged. Indeed, both raise a number of related, albeit very complex, philosophical problems. In recent years, the phenomenology of health and disease has become a major topic in bioethics and the philosophy of medicine, owing much to the work of Havi Carel (2007, 2011, 2018). Surprisingly little attention, however, has been given to the phenomenology of animal health and suffering. This omission shall be remedied here, laying the groundwork for the phenomenological evaluation of animal health and suffering.
... 24,25 SSI is diagnosed in up to 68% of cases after limb-sparing surgery, whereas SSI is diagnosed in up to 12.8% cases after amputation. 20,26 The effect of SSI on MST in the curativeintent treatment of OSA with amputation is unknown, justifying clinical investigation. ...
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Objective To determine the influence of surgical site infection (SSI) on the median disease‐free interval (DFI) and median survival time (MST) in dogs after amputation in the curative‐intent treatment of appendicular osteosarcoma (OSA). Study design Multi‐institutional retrospective cohort study. Animals Fifteen dogs with OSA and SSI, and 134 dogs with OSA and no SSI. Methods Medical records were reviewed, and dogs were included if the following criteria were met: histologic confirmation of OSA, no evidence of metastasis, ≥1 chemotherapy treatment, and available follow‐up data. We used the definition of SSI from the Centers for Disease Control and Prevention. Kaplan‐Meier estimates of median DFI and MST for the SSI and non‐SSI groups were compared by log‐rank test. Univariate and multivariate Cox proportional hazard regression analysis was evaluated for associations with DFI and survival. Results The median DFI and MST of all OSA dogs were 236 days (95% CI, 181‐283) and 283 days (95% CI 237‐355), respectively. The median DFI of dogs with SSI (292 days) did not differ from that of dogs without SSI (224 days, P = .156). The MST of dogs with SSI (292 days) did not differ from that of dogs without SSI (280 days, P = .417). Failure to complete chemotherapy was associated with decreased DFI and survival (P < .001). Adjustments for chemotherapy completion found no effect of SSI on survival. Conclusion SSI did not influence the survival of dogs with appendicular OSA treated with amputation and curative‐intent treatment. Clinical significance The extended survival associated with SSI after limb‐spare surgery for OSA does not appear to be present after amputation. Interactions between the canine immune system and OSA warrant additional study.
... Forelimb amputation memiliki beberapa kelebihan yaitu lebih mudah, resiko post operasi rendah, dan alat yang digunakan minim. Komplikasi cedera pada anjing dan kucing dengan pelvic atau thoracic limb amputation menunjukkan hasil minor dan dapat diselesaikan setelah perawatan (Raske et al. 2015). Teknik ini tidak perlu pemotongan tulang dan tidak meninggalkan sisa tulang dan dapat meningkatkan peluang hewan untuk mendapatkan kembali kualitas hidupnya (Forster et al. 2010, Dickerson et al. 2015. ...
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ABSTRAK: Amputasi kaki depan adalah salah satu tindakan operasi yang dilakukan pada seekor kucing akibat adanya trauma pada kaki depan yang tidak mungkin untuk disembuhkan. Seekor kucing domestic short hair jantan berusia 1 tahun tidak dapat berjalan, dibawa oleh klien ke Rumah Sakit karena tertabrak kendaraan satu minggu sebelumnya. Kondisi luka terbuka pada kaki depan kanan mengalami abses dan berbau busuk. Krepitasi teraba pada tulang yang mengarah ke kondisi fraktur pada tulang radius ulna. Operasi amputasi kaki depan diambil sebagai langkah untuk menyelamatkan kehidupan pasien. Terapi post operasi yang diberikan antara lain analgesik, NSAID, antibiotik, dan multivitamin. Luka pascaoperasi sembuh dengan baik dan tidak ada komplikasi. Kucing mulai belajar berjalan menggunakan ketiga kaki yang lain pada hari ketiga.
... A limb amputation is a surgical procedure that, in some cases, can lead to stump infections and/or wound dehiscence, described in both human (Dunkel et al. 2012) and veterinary medicine (Kaufman and Mann 2013). This procedure is commonly performed in small animals, and it is indicated for unresectable neoplasms, severe fractures, ischemic necrosis, soft tissue infections, paralysis, or congenital deformities (Fitzpatrick et al. 2011;Raske et al. 2015). The main cases described are bone infections (56%), abscesses or haematomas requiring a flap elevation (41%), and a partial (19%) or complete flap loss (15%) (Harris et al. 2009). ...
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In human medicine, skin grafting is an innovative surgical technique widely used in reconstructive surgery to repair skin loss. This case evaluated the effectiveness of a treatment with dermal micro-grafting obtained through the Rigenera ® technology in a chronic open wound resulting from a suture dehiscence of a limb amputation in a cat. Significant differences were observed between the aesthetic aspects of the injury using traditional treatments (cleaning and curettage) and the regenerative technology. The results showed that the healing periods were significantly reduced after the Rigenera ® treatment and that, moreover, a perfect skin status and a complete reduction in the wound area (100%) were achieved in one month. Given these results, Rigenera ® has proven to be a simple yet highly effective method in the treatment of inactivated chronic wounds.
... illness, and we will now turn to whether phenomenology can illuminate PC in non-human animals. Recent work by Menchetti et al. (2017) on PC in dogs is the first of its kind. While there has been prior work on the ability of small animals with amputated legs to adapt and the impact on their welfare (Kirpensteijn et al., 1999;Dickerson et al., 2015;Raske et al,. 2015), no work has focused on the question of whether they are able to experience phantom limbs. Menchetti et al. (2017) created a survey for dog owners in order to "identify signs and behaviors suggestive of neuropathic pain, evaluate risk factors associated with PC occurrence, and determine the owners' perceptions of the quality of life (Qo ...
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What is it like to be a bat? What is it like to be sick? These two questions are much closer to one another than has hitherto been acknowledged. Indeed, both raise a number of related, albeit very complex, philosophical problems. In recent years, the phenomenology of health and disease has become a major topic in bioethics and the philosophy of medicine, owing much to the work of Havi Carel (2007, 2011, 2018). Surprisingly little attention, however, has been given to the phenomenology of animal health and suffering. This omission shall be remedied here, laying the groundwork for the phenomenological evaluation of animal health and suffering.
... Recent work by Menchetti et al. (2017) on PC in dogs is the first of its kind. While there has been prior work on the ability of small animals with amputated legs to adapt and the impact on their welfare (Kirpensteijn et al. 1999;Dickerson et al. 2015;Raske et al. 2015), no work has focused on the question of whether they are able to experience phantom limbs. Menchetti et al. (2017) created a survey for dog owners in order to "identify signs and behaviors suggestive of neuropathic pain, evaluate risk factors associated with PC occurrence, and determine the owners' perceptions of the quality of life (QoL) of their 3-legged pets" (p. ...
Chapter
Full-text available
What is it like to be a bat? What is it like to be sick? These two questions are much closer to one another than has hitherto been acknowledged. Indeed, both raise a number of related, albeit very complex, philosophical problems. In recent years, the phenomenology of health and disease has become a major topic in bioethics and the philosophy of medicine, owing much to the work of Havi Carel (2007, 2011, 2018). Surprisingly little attention, however, has been given to the phenomenology of animal health and suffering. This omission shall be remedied here, laying the groundwork for the phenomenological evaluation of animal health and suffering.
... Amputation of a limb is performed to manage complex fractures, neoplasia, osteomyelitis, soft tissue infection, and limb deformities that cause severe disability in dogs [1]. While recovery after thoracic limb or hind limb amputation is satisfactory in most instances the posture and mobility of amputee dogs vary widely [1][2][3]. The loss of a limb results in an increase in the ground reaction forces and contact times of the remaining limbs. ...
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To assess the relative importance of risk factors for surgical-site infections (SSIs) in orthopedic patients and thereby determine which risk factors to monitor in the national surveillance of SSI in The Netherlands. Reanalysis of data on SSI and associated risk factors from two surveillance projects on nosocomial infections, carried out in 1992 and 1993 in The Netherlands: Project Surveillance Nosocomial Infections in the region of Utrecht (PSZU) and the first Project Surveillance Surgical Wound Infections (SWIFT-1). Odds ratios (ORs) were calculated for age, gender, preoperative stay, and the number of operations. In addition, in PSZU, other nosocomial infections, and, in SWIFT-1, prophylactic antibiotics, acute surgery, and wound contamination were studied. The study was confined to hospitalized orthopedic patients (PSZU, 4,872; SWIFT-1, 6,437). In PSZU, the following ORs were significant in a multivariate model: age 0-44 years, 1.0; 45-64 years, 1.6; 65-74 years, 4.7; and 75-99 years, 6.0. For a preoperative stay over 4 days, the OR was 3.3 (95% confidence interval [CI95], 2.5-4.0), and for multiple surgery, 2.5 (CI95, 1.9-3.0). For females, the OR was 0.8 (not significant). The same model applied to SWIFT-1 gave similar ORs. Adjustment for additional nosocomial infections (PSZU) decreased the ORs for ages over 65 years remarkably. The OR for additional nosocomial infections in patients under 65 years of age was 15.6 (CI95, 4.3-57.4). Adjustment for prophylactic antibiotics, acute surgery, and wound-contamination class (SWIFT-1) did not influence the ORs of the original model, but showed that wound-contamination class was an important risk factor. Age, additional nosocomial infections, wound-contamination class, preoperative stay, and the number of operations were identified as important risk factors for SSI in Dutch orthopedic patients.
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An increasing number of older persons undergo surgery, but the relationship between increasing age and risk of surgical site infection (SSI) has not been established. The objective of the present study was to determine the relationship between increasing age and risk of SSI. The present cohort study included patients who underwent surgery between February 1991 and July 2002. Patients >17 years of age were divided randomly into derivation and validation cohorts. The study was conducted at 11 hospitals. SSIs were prospectively identified by use of Centers for Disease Control and Prevention criteria. The study included 144,485 consecutive surgical patients and 1684 SSIs (rate of SSI, 1.2%). There were 72,139 procedures and 873 SSIs in the derivation cohort. Adjusted analyses revealed a significant relationship between age and risk of SSI (P=.006). Risk of SSI increased by 1.1%/year between ages 17 and 65 years (P=.002). At age >/=65 years, risk of SSI decreased by 1.2% for each additional year (P=.008). There were 72,334 procedures and 811 SSIs in the validation cohort. The relationship between age and risk of SSI was similar in the validation cohort. Increasing age independently predicted an increased risk of SSI until age 65 years. At ages >/=65 years, increasing age independently predicted a decreased risk of SSI.
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Hypothesis Infectious complications are the main causes of postoperative morbidity in abdominal surgery. Identification of risk factors, which could be avoided in the perioperative period, may reduce the rate of postoperative infectious complications.Design A database was established from 3 prospective, randomized, multicenter studies. Multivariate analysis was performed using nonconditional logistic regression expressed as an odds ratio (OR).Setting Multicenter studies (ie, private medical centers, institutional hospitals, and university hospitals).Patients From June 1982 to September 1996, a database was established containing the information of 4718 patients who underwent noncolorectal abdominal surgery.Main Outcome Measures The dependent variables studied included surgical site infection (SSI) (divided into parietal and deep infectious complications with or without fistulas) and global infectious complications (SSI and extraparietal and abdominal infectious complications).Results The rate of global infectious complications was 13.3%; SSI, 4.05%; parietal infectious complications, 2.2%; deep infectious complications with fistulas, 2.18%; and deep infectious complications without fistulas, 1.38%. In multivariate analysis, the following 7 independent risk factors for global infectious complications have been identified: age (60-74 years, OR, 1.64; ≥75 years, OR, 1.45); being underweight (OR, 1.51); having cirrhosis (OR, 2.45), having a vertical abdominal incision (OR, 1.66); having a suture placed or an anastomis of the bowel (OR, 1.48) in the digestive tract; having a prolonged operative time (61-120 minutes, OR, 1.66; 121 minutes, OR, 2.72); and being categorized as having a class 4 surgical site (ie, obese patients or having a risk factor of a healing defect) (OR, 1.66). Ceftriaxone sodium therapy was identified as a protective factor (OR, 0.43). In multivariate analysis, the following 5 independent risk factors for SSI have been identified: the existence of a preoperative cutaneous abscess or cutaneous necrosis (OR, 4.75), having a suture placed or an anastomosis of the bowel (OR, 1.82) in the digestive tract, having postoperative abdominal drainage (OR, 2.15), undergoing a surgicial procedure for the treatment of cancer (OR, 1.74), and receiving curative anticoagulant therapy (OR, 3.33) postoperatively.Conclusions Our data show that risk factors for SSI and for global infectious complications are disparate. Indeed, only the placement of a suture or having an anastomosis of the bowel in the digestive tract is a risk factor for both SSI and global infections. Some of these factors may be modifiable before or during the surgical procedure to reduce the infection rate or to prevent postoperative complications.
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To obtain estimates of the frequency of nosocomial infections nationwide, those occurring at the four major sites-urinary tract, surgical wound, lower respiratory tract and bloodstream-were diagnosed in a stratified random sample of 169,526 adult, general medical and surgical patients selected from 338 hospitals representative of the "mainstream" of U.S. hospitals. We estimate that in the mid-1970s one or more infections developed in 5.23 percent (± 0.16) of the patients and that 6.62 (± 0.24) infections occurred among every 100 admissions. Risks were significantly related to age, sex, service, duration of total and of preoperative hospitalization, presence of previous nosocomial or community-acquired infection, types of underlying illnesses and operations, duration of surgery, and treatment with urinary catheters, continuous ventilatory support or immunosuppressive medications. Seventy-one percent of the nosocomial infections occurred in the 42 percent of patients undergoing surgery and 56 percent in the 38 percent financed by Medicare, Medicaid or other public health care plans.
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Objective: To determine complications and outcomes for dogs that underwent digit amputation. Design: Retrospective case series and owner survey. Animals: 33 client-owned dogs. Procedures: Medical records of dogs that underwent digit amputation were evaluated. Signalment, digits amputated, level of amputation, reason for amputation, and complications were recorded. Owners were contacted via mail or telephone to collect follow-up information. Results: 35 digit amputation procedures were performed for the 33 dogs in the study (1 dog underwent 3 procedures). Short-term (≤ 14 days) complications other than lameness were detected in dogs after 13 of 33 (39.4%) procedures for which follow-up information was available; incisional dehiscence was the most common short-term complication. Long-term (>14 days) lameness was detected in dogs after 8 of 32 (25.0%) procedures for which follow-up information was available; lameness was mild or intermittent after 6 of these procedures. Amputation of a digit in a hind limb was the only variable that was significantly associated with the development of short-term complications. Twenty-four of 33 (72.7%) owners responded to the survey via mail or telephone interview; 23 (95.8%) of those owners were satisfied with the procedure. Most dogs had a good functional outcome (including dogs that underwent amputation of digit 3 or 4 or both). Conclusions and clinical relevance: Amputation of a hind limb digit was the only risk factor identified for development of short-term complications. Dogs that underwent amputation of digit 3 or 4 or both did not seem to have a worse outcome than dogs that underwent amputation of other digits.
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Objective: To compare surgical site infection and inflammation rates between the use of nonimpregnated (polydioxanone and poliglecaprone 25) versus triclosan-impregnated (polydioxanone and poliglecaprone 25) suture for incisional closure in dogs undergoing a standardized orthopedic procedure (tibial plateau leveling osteotomy [TPLO]). Design: Retrospective cohort study. Animals: 283 dogs that underwent TPLO between November 2005 and December 2009. Procedures: Medical records were reviewed for age; body weight; body condition score; use of propofol; perioperative and postoperative administration of antimicrobials; presence of a preoperative infection; use of a jig; technique of joint exploration; type of suture material (triclosan impregnated vs nonimpregnated) used to close the pes anserinus, subcutaneous layer, and subcuticular layer; use of staples or suture to close the skin; and surgery and anesthesia durations. The outcome variables were surgical site inflammation and infection. Results: Rates of infection and inflammation did not differ between surgeries for which triclosan-impregnated suture was used (n = 159 [8.8%, and 18.8%, respectively]) and those for which nonimpregnated suture was used (112 [10.7% and 15.2%, respectively]). The use of staples, compared with suture, to close the skin significantly decreased the inflammation rate. Conclusions and clinical relevance: Compared with in vitro conditions, in vivo conditions (where the environment is not controlled and triclosan may elute more quickly from the suture) may decrease the antibacterial effectiveness of triclosan-impregnated suture. On the basis of our findings, triclosan-impregnated sutures did not seem to provide an additional benefit for clinical use and cannot be strongly recommended for elective orthopedic procedures in veterinary medicine.
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To evaluate the effects of epsilon aminocaproic acid (EACA) on the prevalence of postoperative bleeding in retired racing Greyhounds (RRG), and to assess its effects on selected thrombelastography (TEG) and fibrinolysis variables. Double-blinded, prospective, randomized study. 100 RRG had elective ovariohysterectomy or orchiectomy and were administered EACA or placebo for 3 days after surgery. TEG variables were analyzed preoperatively and 24, 48, and 72 hours after surgery. Thirty percent (15/50) of RRG in the placebo group had delayed postoperative bleeding starting 36–48 hours after surgery compared with 10% (5/50) in the EACA group (P = .012). On the TEG variables, the slopes for R and K time were significantly different between treatment groups (P <.05); the R and K time decreased over time in the EACA group after surgery whereas they increased in the placebo group. The angle, maximal amplitude (MA), and G slopes were also significantly different between treatment groups (P = .001, .001, and .006, respectively). The angle, MA, and G increased postoperatively over time in the EACA group and decreased in the placebo group. All these changes are supportive of hypercoagulability associated with EACA administration. Postoperative administration of EACA significantly decreased the prevalence of postoperative bleeding in RRG undergoing surgery by increasing the clot strength.
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The purpose of this randomized clinical trial was to compare the efficacy of three patient warming devices (i.e., circulating water blanket, forced-air, and warming panels) used either alone or in combination on patients undergoing surgeries lasting >60 min. In total, 238 dogs were included and divided into either the celiotomy or nonceliotomy group. Dogs in each group were further divided into one of three subgroups. Dogs in subgroup 1 (n=39) were placed on a circulating water blanket with a forced-air warming blanket placed over the trunk. Subgroup 2 dogs (n=40) were placed on a forced-air warming blanket only. Subgroup 3 dogs (n=40) were placed on warming panels. Significant temperature drops occurred from time of induction (38.1°C±0.64°C) to the start of surgical procedures (36.7°C±0.95°C). Although body temperature was maintained once the warming units were started in all groups, there were significant differences in temperatures for the type of surgical procedures (i.e., celiotomies versus nonceliotomies) performed over time except for subgroup 3. The warming panels and forced-air devices were equally effective in preserving body temperature in anesthetized patients.
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Questionnaires were distributed to owners of cats that had undergone limb amputation in the UK, through 1000 veterinary clinics or publications relating to companion cats, or online. Between July 2009 and February 2010, responses were received relating to 234 cats, and data for 204 of these were included in subsequent analyses. The responses received provided data on signalment, aetiology, quality of life, behavioural changes and pain observed in cats after partial or total amputation of a limb. Young male domestic shorthair cats were over-represented in the sample; the most common reason for amputation was a fractured bone, and the hindlimb was almost twice as likely to be amputated as the forelimb. Although 89 per cent of the cats received analgesics/anti-inflammatories after discharge, the owners of 35 per cent of the animals observed some signs of pain during recovery. Eighty-nine per cent of the cats were thought to have regained a 'normal' quality of life as defined by the owner and 94 per cent of the owners stated that they would agree with the decision to amputate the affected limb in a pet if faced with the same decision again.
Article
Two thousand sixty-three surgical procedures were performed on 1992 patients (1715 dogs and 277 cats). In a retrospective analysis, the procedures were categorized according to the expected degree of wound contamination, and corresponding wound infection rates were determined. The number of procedures in each category and the percent that became infected were as follows: clean (1100, 2.5%), clean-contaminated (554, 4.5%), contaminated (172, 5.8%), and dirty (237, 18.1%). The administration of antibiotics significantly reduced the frequency of wound infection in clean surgical procedures performed by senior veterinary students (p less than 0.05), but not in clean elective procedures performed by faculty or resident surgeons that required 90 minutes or less to complete. There was a significant correlation between elevation of rectal temperature postoperatively and increased duration of the surgical procedure. However, the rectal temperature measured the day after surgery was not an accurate predictor of wound infection.
Article
To determine postoperative wound infection rates in dogs and cats for various wound contamination categories and to identify factors that influence postoperative wound infection rates. Epidemiologic study. 1,574 wounds in 1,255 dogs and cats. Information recorded included signalment, nutritional status, surgery duration, surgical procedures, wound contamination classification, interval from clipping until surgery, blood pressure values, active infection at a distant site, endocrinopathy, and administration of immunosuppressive medications or antibiotics. Relative risk, 95% confidence intervals, and multiple regression analyses were performed. Postoperative infection was evident in 86 of 1,574 (5.5%) wounds, including 54 of 1,146(4.7%) and 13 of 259 (5.0%) animals with clean and clean-contaminated wounds respectively, and 12 of 100 (12.0%) and 7 of 69 (10.1%) animals with contaminated and dirty wounds, respectively. Animals with clean wounds that received antibiotics other than as prescribed in our perioperative protocol had a higher infection rate than animals that did not receive antibiotics. Surgical sites clipped before anesthetic induction were 3 times more likely to become infected than sites clipped after induction. Risk of wound infection increased with increasing duration of surgery. Wound contamination categories had too much variation to make them useful for predicting animals that would develop wound infections. Surgical sites should be clipped immediately prior to surgery, and intraoperative time should be kept to a minimum. Unless indicated for other current active infection, prolonged use of antibiotics after surgery should be avoided in animals with clean wounds.
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The complications and mortality associated with anesthesia of dogs and cats in a university teaching hospital were determined. During one year, 2,556 dogs and 683 cats were anesthetized by the anesthesia service. Hypotension occurred in 179 (7%) dogs and 58 (8.5%) cats. Cardiac dysrhythmias occurred in 64 (2.5%) dogs and 12 (1.8%) cats. Transfusions were required in 31 (1.2%) dogs. Hypercapnea occurred in 33 (1.3%) dogs and one (less than 1%) cat. Hypoxemia occurred in 14 (0.5%) dogs. Anesthetic complications, as defined, occurred in 12.0% of dogs and 10.5% of cats, while deaths associated with the perianesthetic period occurred in 0.43% of dogs and 0.43% of cats.
Article
Force plate analysis was used to measure ground reaction forces (GRF) and contact times, and calculate the centre of gravity at a walk of 10 dogs which had had a limb amputated, and the results were compared with the results from 22 normal dogs of the same weight. The loss of a limb caused significant changes in the GRF, impulses and contact times of the remaining limbs and in the location of the dogs' centre of gravity. The changes were greater in dogs which had lost a forelimb than in dogs which had lost a hindlimb.
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To determine the effects of hypothermia and duration of anesthesia on the infection rate in clean wounds in dogs and cats. Retrospective clinical study. Seven hundred seventy-seven dogs and cats undergoing clean surgical procedures. Records of animals prospectively evaluated for postoperative wound infection were retrospectively evaluated for the prevalence of perioperative hypothermia. Body temperatures during the perioperative period and the duration of surgery and anesthesia were recorded. Data were analyzed to identify differences between animals with infected and uninfected wounds and multiple logistic regression modeling was used to evaluate the independent contribution of risk factors to the incidence of postoperative wound infection. No statistically significant differences were found in the analysis of temperature data between animals with infected and uninfected wounds. Duration of anesthesia was significantly greater in animals with wound infections (P = .01). Multiple logistic regression modeling identified duration of anesthesia as a risk factor for postoperative wound infection independent of the duration of surgery. In animals with clean surgical wounds, mild perioperative hypothermia is not a significant risk factor for postoperative wound infection. The duration of anesthesia, however, is a significant risk factor independent of the duration of surgery. To decrease the incidence of postoperative wound infection, the duration of anesthesia should be minimized. Surgical time, as well as the time required for ancillary diagnostic tests while under anesthesia should, therefore, be kept to a reasonable minimum.
Article
To study postoperative infections in hospital and after discharge, and to identify the risk factors for such infections. Prospective cohort study, with telephone follow-up for 1 month after hospital discharge. The general surgery service of a tertiary hospital in Spain. In-hospital and postdischarge surgical-site infection (SSI), always confirmed by a physician. Of the 1,506 patients initially enrolled, 29 died during hospital stay, and 33 were lost to postdischarge follow-up. An SSI was identified prior to discharge in 123 patients and after discharge in 103. For several variables (age, serum albumin, glycemia, lengths of preoperative and postoperative hospital stay, etc), there were no differences between patients with postdischarge SSI and noninfected patients; however, there were differences detected between patients with postdischarge SSI and in-hospital SSI, as well as between patients with in-hospital SSI and noninfected patients. The analysis of risk factors showed that most predictors for in-hospital SSI did not behave in the same manner for postdischarge SSI. Stepwise logistic regression only identified chemoprophylaxis, age (advanced age was a preventive factor), and body mass index as independent risk factors for postdischarge SSI. Differences in risk factors between in-hospital and post-discharge SSIs remained even after controlling for time from operation to diagnosis. Most predictors of in-hospital SSI were not predictors of postdischarge SSI.
Article
We have developed and analyzed a large surgical prophylaxis database and now report the factors significantly associated with early infection, readmission due to infection, and death within 28 days of surgery. This study is intended to be a stepping-stone for further studies using our clinical database. A computerized database of 9,016 surgical patients from a 400-bed community hospital was examined. Multivariate logistic regression and tree-based modeling were used to identify factors associated with the outcomes. Factors considered included surgical procedure, prophylactic antibiotic, age, gender, serum creatinine, and albumin. 12.6% had an early infection, 2.5% were readmitted due to infection, and 2.5% died within 28 days. Most combination prophylactic antibiotics were associated with an increased probability of an early infection. Decreased albumin and increased age were associated with an increased probability of an early infection. Tracheostomy and amputations were associated with an increased probability of an early infection, whereas gallbladder and orthopedic procedures involving the arm were associated with a decreased probability. Factors associated with readmission due to infection included dialysis shunt, vascular repair, and an early infection. Factors associated with increased probability of death within 28 days included age, albumin, serum creatinine, and an early infection. Gallbladder procedures and obstetric-gynecologic procedures were associated with a decreased probability of death within 28 days. Older patients and those with a decreased albumin were most likely to have an early infection. To the extent that an early infection was a significant risk factor for readmission due to infection, the impact of age and albumin on the probability of readmission due to infection is demonstrated by their effects on early infections. Interestingly, albumin and age were significantly associated with death within 28 days, in addition to early infection, showing the predictive association between these factors and early death.
Article
Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. During 1986-1996 the Center for Disease Control and Prevention's National Nosocomial Infections Surveillance system reported 15,523 SSI following 593,344 operations (2.6%). Previous studies have documented patient characteristics associated with an increased risk of SSI, including diabetes, tobacco or steroid use, obesity, malnutrition, and perioperative blood transfusion. In this study we sought to reevaluate risk factors for SSI in a large cohort of noncardiac surgical patients. Prospective data (NSQIP) were collected on 5031 noncardiac surgical patients at the Veteran's Administration Maryland Healthcare System from 1995 to 2000. All preoperative risk factors were evaluated as independent predictors of surgical site infection. The mean age of the study cohort was 61 plus minus 13. SSI occurred in 162 patients, comprising 3.2% of the study cohort. Gram-positive organisms were the most common bacterial etiology. Multiple logistic regression analysis documented that diabetes (insulin- and non-insulin-dependent), low postoperative hematocrit, weight loss (within 6 months), and ascites were significantly associated with increased SSI. Tobacco use, steroid use, and chronic obstructive pulmonary disease (COPD) were not predictors for SSI. This study confirms that diabetes and malnutrition (defined as significant weight loss 6 months prior to surgery) are significant preoperative risk factors for SSI. Postoperative anemia is a significant risk factor for SSI. In contrast to prior analyses, this study has documented that tobacco use, steroid use, and COPD are not independent predictors of SSI. Future SSI studies should target early preoperative intervention and optimization of patients with diabetes and malnutrition.
Article
To evaluate risk factors for development of postoperative wound infections in clean-contaminated wounds. Retrospective clinical study. Two hundred thirty-nine dogs and cats that had clean-contaminated surgical procedures. Records of animals that had a clean-contaminated surgical procedure and were prospectively monitored for development of postoperative wound infection were reviewed. Prospective data included signalment, nutritional status, body weight, duration of surgery, surgical procedures, wound classification, surgical site clip time before surgery, hypotension during surgery, the presence of an active distant infection, endocrinopathy, administration of an immunosuppressive agent, administration of antibiotics, and the type of antibiotic used. Additional retrieved data included total anesthesia time, temperature variables, blood loss, and suture material used. Intact males (P =.008) and animals with concurrent endocrinopathy (P =.008) were at a higher risk of development of postoperative wound infection. Total surgery time (P =.02) and total anesthesia time (P =.04) were longer in animals that developed postoperative wound infection. No other factors were statistically significant. Intact males and animals with a concurrent endocrinopathy were at higher risk of postoperative wound infection after clean-contaminated surgical procedures. Time under anesthesia and duration of surgery should be minimized to reduce the risk of wound infection in clean-contaminated surgical procedures.
Article
Infectious complications are the main causes of postoperative morbidity in abdominal surgery. Identification of risk factors, which could be avoided in the perioperative period, may reduce the rate of postoperative infectious complications. A database was established from 3 prospective, randomized, multicenter studies. Multivariate analysis was performed using nonconditional logistic regression expressed as an odds ratio (OR). Multicenter studies (ie, private medical centers, institutional hospitals, and university hospitals). From June 1982 to September 1996, a database was established containing the information of 4718 patients who underwent noncolorectal abdominal surgery. The dependent variables studied included surgical site infection (SSI) (divided into parietal and deep infectious complications with or without fistulas) and global infectious complications (SSI and extraparietal and abdominal infectious complications). The rate of global infectious complications was 13.3%; SSI, 4.05%; parietal infectious complications, 2.2%; deep infectious complications with fistulas, 2.18%; and deep infectious complications without fistulas, 1.38%. In multivariate analysis, the following 7 independent risk factors for global infectious complications have been identified: age (60-74 years, OR, 1.64; >or=75 years, OR, 1.45); being underweight (OR, 1.51); having cirrhosis (OR, 2.45), having a vertical abdominal incision (OR, 1.66); having a suture placed or an anastomis of the bowel (OR, 1.48) in the digestive tract; having a prolonged operative time (61-120 minutes, OR, 1.66; 121 minutes, OR, 2.72); and being categorized as having a class 4 surgical site (ie, obese patients or having a risk factor of a healing defect) (OR, 1.66). Ceftriaxone sodium therapy was identified as a protective factor (OR, 0.43). In multivariate analysis, the following 5 independent risk factors for SSI have been identified: the existence of a preoperative cutaneous abscess or cutaneous necrosis (OR, 4.75), having a suture placed or an anastomosis of the bowel (OR, 1.82) in the digestive tract, having postoperative abdominal drainage (OR, 2.15), undergoing a surgical procedure for the treatment of cancer (OR, 1.74), and receiving curative anticoagulant therapy (OR, 3.33) postoperatively. Our data show that risk factors for SSI and for global infectious complications are disparate. Indeed, only the placement of a suture or having an anastomosis of the bowel in the digestive tract is a risk factor for both SSI and global infections. Some of these factors may be modifiable before or during the surgical procedure to reduce the infection rate or to prevent postoperative complications.
Article
To assess postoperative surgical site infection (SSI) rate and to identify associated predictive factors. Prospective clinical study. Dogs and cats that had surgery (1010 interventions) during 58 weeks from April 1999 to June 2000. Data sheets were completed by clinicians. Patients were controlled for clinical evidence of SSI at suture removal. Two definitions of SSI ("infection" and "infection/inflammation") were developed specifically for this study and used for statistical analysis. Logistic regression models were built in order to identify significant predictive factors for SSI. Wounds with "infection/inflammation" occurred in 5.8% and "infected" wounds in 3% of patients. The outcome "infection" was associated with 3 major risk factors (duration of surgery, increasing number of persons in the operating room, dirty surgical site) and 1 protective factor (antimicrobial prophylaxis). The outcome "infection/inflammation" was associated with 6 significant factors (duration of anesthesia, duration of postoperative intensive care unit stay, wound drainage, increasing patient weight, dirty surgical site, and antimicrobial prophylaxis). SSI frequency in companion animals is comparable with the frequency observed in human surgical patients. Several significant predictive factors for SSI in small animals surgery were identified. Baseline information for SSI surveillance in our hospital and for comparison with other studies was defined. The factors identified may help to predict infections in surgical patients and to take adequate preventive measures for patients at risk.
Article
Some retired racing Greyhounds (RRG) that undergo surgery bleed excessively. Hypothesis: Greyhounds that bleed excessively will have one or more preoperative hemostatic abnormalities that can be used to predict the risk and severity of postoperative bleeding. Eighty-eight RRG undergoing ovariohysterectomy or castration. All dogs were evaluated preoperatively with a physical exam, CBC, platelet count, OSPT, APTT, platelet function with PFA-100(a); fibrinogen, d-dimer, plasminogen (Plmg), antiplasmin (AP), antithrombin (AT), and vWF concentration (vWF:Ag); vWF collagen binding assay (vWF:CBA), and Factor XIII assay. Assays were repeated in the dogs that bled, and in an age- and sex-matched control group of RRG. Twenty-six percent of the dogs had bleeding 36-48 hours after surgery. AP (P <.0001) and AT concentration (P= .007) were significantly lower, and vWF:CBA (P= .0284) was higher preoperatively in the dogs with excessive hemorrhage. A lower platelet count (P= .001) and hematocrit (P= .002), shorter OSPT (P= .0002) and higher plasma fibrinogen (P <.0001), and AP (P= .001) concentration were detected at the time of bleeding compared with preoperative values in the dogs that bleed excessively. The same findings were observed postoperatively for the control group, except for the decrease in hematocrit. The results indicate that this excessive postoperative bleeding is not attributable to a primary or secondary hemostatic defect, but could result from altered fibrinolysis.
Article
To report surgical planning, technique, and long-term outcome of custom transcutaneous tibial implants used to restore ambulation after bilateral pelvic limb amputation in a dog. Case report. A 4-year-old, 25.5 kg, female spayed, Siberian Husky. Computed tomographic scans of the pelvic limbs were used to build sterolithographic models of the remaining tibia after bilateral amputation of the distal aspect of the tibiae. The sterolithographic models facilitated fabrication of implants that would replace the missing distal segments of the tibiae. Custom implants were surgically placed in both limbs. Assisted ambulation was restored immediately postoperatively and unassisted locomotion occurred at 7 days. At 14 months, aseptic loosening of the right implant occurred, it was removed and a 2nd transcutaneous implant was fabricated and implanted. At 26 months after initial surgery and 17 months after revision of the right implant, function is restored at a walk, trot, and run. Based on over a 2-year follow-up, transcutaneous tibial implants allowed for restoration of locomotion. Transcutaneous tibial implants offer a potentially viable treatment option for restoring ambulation after amputation of the distal aspect of the tibiae in the dog.
Veterinary Surgery: Small Animal
  • B. Séguin
  • J. P. Weigel