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Complications in Spay and Neuter Surgery
Abstract
This chapter focuses on a discussion of surgical complications – their presentation, treatment, prognosis, and, most importantly, prevention. It defines “surgical complications” as “any unexpected/unplanned/unwanted experience or outcome for the patient that causes either mortality, or sufficient morbidity to require further medical attention.” Every aspect of surgical complications – monitoring, preventive measures, management, reporting – must be assigned a central role in spay and neuter surgery, no different from any other major surgical procedure. In order to make an organized discussion of the topic of surgical complications, they can be categorized as intraoperative complications versus post‐operative complications, according to the timeframe in which the complication first becomes evident. This is a somewhat arbitrary categorization, as many complications that become evident in the post‐operative period occur because of some error or oversight during surgery. The chapter describes the surgical complications of spay and neuter surgery in terms of its recognition, cause, treatment, and prevention.
Objective:
To determine the rate of complications associated with the ovarian pedicle tie procedure in cats undergoing ovariohysterectomy and examine whether cat characteristics or surgeon experience level were associated with complications.
Animals:
15,927 cats that underwent ovariohysterectomy with the ovarian pedicle tie procedure between January 1, 2017, and December 31, 2018.
Procedures:
Data were extracted from electronic and paper medical records. Complications were coded by a veterinarian blinded to surgeon experience level. Complications (pedicle drop or tear, pedicle hemorrhage, and pedicle-related death) were summarized as counts and percentages. Univariate associations between cat characteristics (eg, age, weight, reproductive status, and ownership) and surgeon experience level (clinic veterinarian vs training veterinarian or veterinary student) and each outcome were estimated separately for veterinarian and student training clinics.
Results:
A pedicle drop or tear occurred in 0.3% (n = 49) of cats and was significantly more likely among veterinary students. Most (41/49 [84%]) pedicle drops and tears did not result in hemorrhage. Only 19 of 15,927 (0.12%) cats had pedicle-related hemorrhage, and in all instances, hemorrhage was corrected intraoperatively without serious complication or death. Cat characteristics and surgeon experience level were not related to pedicle hemorrhage.
Clinical relevance:
Results support previous evidence that the ovarian pedicle tie procedure is safe in cats undergoing ovariohysterectomy when performed by experienced surgeons or novice surgeons under supervision. Given the reduced anesthetic time associated with the procedure, the ovarian pedicle tie should be considered an acceptable standard practice in all practice settings.
Objective
To compare time efficiency and nociceptive input between digital strumming (DS) and sharp transection (ST) of the suspensory ligament during ovariohysterectomy (OVH).
Study design
Randomized controlled trial.
Animals
30 adult female dogs.
Methods
Dogs were randomly assigned to ST or DS procedures. Measures of nociception were assessed through measurements of preoperative and intraoperative heart rate during manipulation of the suspensory ligament. Measures of pain were assessed through preoperative and postoperative pain scores by using the short form Glasgow Composite Pain Scale. Time efficiency was measured through total surgical time and the time to release each suspensory ligament.
Results
After body weight was accounted for, the total surgical time was 1.1 minutes (P = .06) faster for ST than for DS, and each additional kilogram of body weight increased total surgical time by 0.1 minutes (P = .02). Digital strumming had 30.6‐fold greater odds of taking greater than 1 minute compared with ST (P = .001). The heart rate from baseline to peak was 7.4 beats per minute lower in the ST group than in the DS group (P = .06). No complications were observed, and there was no difference in postoperative pain scores between treatments.
Conclusion
Sharp transection was faster and generated less intraoperative acceleration in heart rate but did not differ in postoperative outcomes compared with DS.
Clinical significance
Sharp transection is a viable alternative to DS for breakdown of the suspensory ligament during canine OVH. Sharp transection may improve surgical efficiency, especially when performing large volumes in the spay/neuter setting and could influence veterinary student training.
Objectives:
To describe a technique using bipolar electrosurgical forceps for haemostasis during open ovariectomy of bitches and queens and for castration of dogs and to determine whether these forceps reduced surgical time compared to ligation with suture.
Materials and methods:
Bipolar electrosurgical forceps were used for haemostasis in 3744 open surgeries including ovariectomies in bitches (n=1406) and queens (n=859) and castrations in dogs (n=1335). The forceps were also used to assist with ovariohysterectomy in bitches (n=89) and queens (n=55). The effect of bipolar electrocoagulation and other likely factors influencing surgical time was examined using linear regression analysis of 367 surgeries.
Results:
The use of the forceps reduced surgical time by 9·7 ±2·8 minutes in bitches and by 3·0 ±1·5 minutes in queens. The complications encountered initially were small superficial skin burns requiring topical treatment and one case of haemorrhage associated with surgical technique.
Clinical significance:
Bipolar electrosurgical forceps reduce surgical time in ovariectomies, and complications are rare. This technique has promise for widespread application in veterinary practice to assist with haemostasis in ovariectomy of bitches and queens.
This study was designed to determine the frequency of postoperative complications following elective surgeries (castration, ovariohysterectomy, onychectomy) of dogs and cats from private practices and to evaluate the use of electronic medical records for this type of research. All elective surgeries performed during the study period at 5 private practices were included. The surgical techniques and materials used for each procedure were similar across practices, but the interpretation of "complication," the amount of detail recorded on the primary medical record, and the intensity of follow-up varied. The frequencies and types of complications varied by species and procedure. The postoperative complication frequencies ranged from 1% to 24% for all complications and 1% to 4% for severe complications. The results of this study describe populations of elective-surgery patients at private practices, provide data for educating clients about the risks associated with these procedures, and demonstrate how computerized records can be used to collect practice-specific medical information.
Veterinary teaching hospitals (VTHs) are experiencing case-load trends that have negatively affected efforts to prepare students for entry-level veterinary practice, particularly in the area of technical skills training. This article examines the clinical training available to veterinary students through a variety of collaborative shelter models. Benefits and potential problems related to initiating a collaborative shelter clinical training program are reviewed. Collaborative efforts between animal shelters and veterinary schools can provide crucial opportunities for outreach teaching initiatives, particularly for teaching medical and surgical skills.
Objective
To determine factors affecting the duration of canine and feline gonadectomies performed by second‐year veterinary students.
Study design
Retrospective study of 1288 gonadectomies.
Sample population
One hundred ninety‐four second‐year veterinary students in a 24‐week veterinary surgical teaching laboratory.
Methods
Surgical and anesthetic records were analyzed and arranged by primary surgeon in chronological order. Species, sex, weight, body condition score, occurrence of an intraoperative complication, and order of sequential cases in the year performed by the primary surgeon were assessed for their influence on anesthesia, surgery, and preparation times.
Results
Each student performed an average of 6.6 (±1.08) gonadectomies over 24 weeks. Dogs, females, increasing weight, intraoperative complications, and earlier sequential cases were associated with longer duration of surgery and anesthesia. These factors accounted for 50% and 59% of anesthetic and surgical time variance, respectively. The rate of intraoperative complications did not change across time but was higher during canine ovariohysterectomies. Duration of anesthesia and surgery for canine orchiectomy decreased by 29 and 21 minutes, respectively, and for canine ovariohysterectomy decreased by 16 and 12 minutes, respectively, over 24 weeks without reaching a learning plateau.
Conclusion
Species, sex, weight, complications, and earlier sequential cases influenced duration of anesthesia and surgery.
Clinical significance
By establishing a baseline for duration of student‐performed surgeries and describing the relative impact of factors influencing duration, students and educators may be able to set goals for student improvement during teaching laboratories.
OBJECTIVE To determine complication rates for elective gonadectomy procedures performed by veterinary students on dogs and cats in an animal shelter, characterize these complications, and compare rates with those for shelter-employed veterinarians (SEVs).
DESIGN Retrospective cohort study.
ANIMALS 10,073 dogs and cats for which gonadectomy was performed by a veterinary student (n = 3,048 surgeries) or SEV (7,025 surgeries) at an urban animal shelter over a 16-month period.
PROCEDURES Electronic medical records for included dogs and cats were reviewed and data collected regarding patient signalment, duration of gonadectomy, surgeon type (student or SEV), and types of surgical complications recorded (including death or euthanasia) during the period from anesthetic induction to 72 hours after surgery. Complication and mortality rates were compared between veterinary students and SEVs.
RESULTS No significant differences were identified between students and SEVs regarding rates of overall complications for both species, minor complications for both species, major complications for both species, and overall complications for dogs or cats specifically. The most common complications were self-limiting, with no long-term consequences, for both students and SEVs. Differences in mortality rates between students and SEVs could not be definitively determined owing to low numbers of nonsurviving patients.
CONCLUSIONS AND CLINICAL RELEVANCE With judicious case selection and as a part of a surgical training program, complication rates for veterinary student–performed gonadectomy procedures for dogs and cats were no different from those for SEV-performed gonadectomy procedures. We believe such information regarding patient outcomes will allow shelter staff to make informed decisions and help them in discussions with stakeholders who may have concerns about student participation.
Objectives:
The objectives of this study were to describe the clinical use and outcome of autologous transfusions in cats with intracavitary haemorrhage.
Methods:
A retrospective descriptive study was performed. Computerised medical records of a single referral centre were searched for cats receiving an autotransfusion. Medical records were evaluated for underlying disease process, autotransfusion technique, autotransfusion volume, time period over which the autotransfusion was given, packed cell volume (PCV) pre- and post-autotransfusion, percentage rise in PCV, use of other blood products and any complications of the procedure. Survival to discharge and survival at 2 months was documented.
Results:
Between July 2012 and March 2018 a total of 12 autotransfusions were performed in eight cats. All patients were diagnosed with haemoperitoneum. Four of the eight cats were diagnosed with abdominal neoplasia, three had postoperative haemorrhage and one had a traumatic haemoperitoneum. Three cats received more than one autotransfusion. Blood was collected using a 23 G butterfly catheter and 20 ml syringe in 7/12 collections, a 23 G needle and 20 ml syringe in 2/12 collections and directly into syringes from the open abdomen at the time of surgery in 3/12 collections. A median volume of 50 ml (range 25-80 ml) was collected and administered, meaning a median volume of 16.5 ml/kg (range 9-26 ml/kg) was administered. The autologous transfusions were given over a median of 3 h (0.25-6 h). Five cats were given another blood product alongside the autotransfusion. Median percentage PCV increase was 5% (range 1-7%). Anticoagulant was used in 5/12 autotransfusions. No clinically relevant adverse effects were reported. Six of the eight cats survived to discharge. Two month survival was 60% (3/5).
Conclusions and relevance:
Autologous transfusion appears to be a safe and effective technique for stabilising cats with haemoperitoneum. This technique allows rapid and cheap provision of blood and avoids the need for an allogenic blood donor.
Objective:
To describe the successful use of an autotransfusion technique utilizing 2 syringes in 4 dogs.
Case series summary:
All 4 dogs in this series had a hemoabdomen and subsequent hypovolemic shock. During surgery blood was collected from the abdominal cavity by the surgeon and passed to an assistant. The blood was then transferred to a second syringe for direct IV administration. The blood was passed through an inline blood filter prior to reaching the patient. Given the transfusion volume and administration time frame, 3 cases were classified as a massive transfusion. All 4 dogs survived the transfusion, were discharged within 3 days of surgery/transfusion and no complications were noted.
New or unique information provided:
This case series describes a relatively simple method of performing an autotransfuion in patients with hemoabdomen and hypovolemic shock.
Objective-To describe the clinical characteristics, treatment, complications, and outcome of dogs and cats treated surgically for major abdominal evisceration. Design-Retrospective case series. Animals-8 dogs and 4 cats. Procedures-Medical records from January 1998 through March 2008 were reviewed to identify animals that underwent surgery for major abdominal evisceration. Data regarding cause of evisceration, signalment, physiologic variables, and hematologic variables were collected. Details of treatment, duration of hospitalization, and outcome were recorded. Linear regression analysis was performed to evaluate the association of signalment, physiologic variables, and hematologic variables on the number of days of hospitalization. Results-Major abdominal evisceration was secondary to a traumatic event in 4 animals and to postsurgical clehiscence in 8 animals. All animals had evisceration of the intestines and gross contamination with dirt, leaves, or litter. Two animals eviscerated the spleen, and 1 animal had a perforated colon and was leaking feces into the peritoneal cavity. All animals underwent exploratory abdominal surgery. Surgical procedures performed included resection of compromised intestine, body wall repair, diaphragmatic hernia repair, nephrectomy, splenectomy, and primary colonic repair. All animals survived to discharge from the hospital. Median duration of hospitalization was 4 days (range, 1 to 7 days). Factors associated with an increase in duration of hospitalization included evisceration secondary to trauma, high lactate concentration at time of admission, and small body size. Conclusions and Clinical Relevance-Despite the dramatic appearance of major abdominal evisceration in cats and dogs, prompt and aggressive medical and surgical intervention can provide a favorable outcome. (J Am Vet Med Assoc 2009;234:1566-1572)
Today we find ourselves in possession of stupendous know-how, which we willingly place in the hands of the most highly skilled people. But avoidable failures are common, and the reason is simple: the volume and complexity of our knowledge has exceeded our ability to consistently deliver it - correctly, safely or efficiently. In this groundbreaking book, Atul Gawande makes a compelling argument for the checklist, which he believes to be the most promising method available in surmounting failure. Whether you're following a recipe, investing millions of dollars in a company or building a skyscraper, the checklist is an essential tool in virtually every area of our lives, and Gawande explains how breaking down complex, high pressure tasks into small steps can radically improve everything from airline safety to heart surgery survival rates. Fascinating and enlightening, The Checklist Manifesto shows how the simplest of ideas could transform how we operate in almost any field.
Objective: Canine ovariohysterectomy (OVH) is one of the most commonly performed surgical procedures in companion animal practice. The aim of the study was to determine the frequency and types of complications related to OVH. Material and methods: The clinical records of all street dogs admitted to the public dog shelters of the Veneto Region (Italy) between January 2010 and December 2011 were reviewed for dogs that had undergone OVH. Specific comparison was made between anaesthesia time, body weight of the patients and intra-and postoperative complications (occurring up to 4 weeks postoperatively). The data were statistically analyzed. Results: Complications were recorded in 141 of 1880 bitches corresponding to an overall complication rate of 7.5%. Mean ± standard deviation (SD) weight of the bitches was 25.7 ± 6.7 kg and mean ± SD anaesthesia time was 42.8 ± 8.6 minutes. Distinct types of complications included significant ovarian artery haemorrhage, haemorrhage from the surgical wound, wound healing complications, urinary incontinence, ovarian remnant syndrome. Twenty-one patients had intraoperative complications and 120 patients had postoperative complications. Analysis of the grouped data showed a significant association between body weight and the incidence of complications. There was also a significant association between anaesthesia time and the incidence of complications. The results of this study indicate that patient weight is related to the incidence of complications and the odds of a complication occurring increase by a factor of 1.03 for every one kilogram of increase in patient weight. The period of general anaesthesia also appears to be related to the incidence of complications and the odds of a complication occurring increase by approximately 2% for each additional minute in anaesthesia time. Conclusion: Increasing patient weight and duration of anaesthesia time were found to be risk factors for the incidence of complications of OVH in the bitch.
OBJECTIVE
To compare closed and open orchidectomy in dogs and the associated complications.METHODSA randomised controlled blinded prospective clinical study of 73 cases was undertaken involving the recording of all complications during and in the 10 days following orchidectomy of dogs fulfilling the standardised inclusion criteria. The active variable was the surgical technique of either open or closed orchidectomy.RESULTSDogs undergoing open orchidectomy experienced significantly more complication events than the dogs undergoing closed orchidectomy [24 of 34 (70%) versus 18 of 39 (46%), P = 0 · 04]. Dogs undergoing open orchidectomy were statistically more likely to develop scrotal complications (21 of 34, 61%) compared with dogs undergoing closed orchidectomy (13 of 39, 33%; P = 0 · 02).CLINICAL SIGNIFICANCEOpen orchidectomy is associated with a higher overall complication rate in the first 10 days after surgery than closed orchidectomy. Open orchidectomy is also associated with increased scrotal complications including swelling, bruising and pain compared with closed orchidectomy.
Approximately 2,700 patients are harmed by wrong-site surgery each year. The World Health Organization created the surgical safety checklist to reduce the incidence of wrong-site surgery. A project team conducted a narrative review of the literature to determine the effectiveness of the surgical safety checklist in correcting and preventing errors in the OR. Team members used Swiss cheese model of error by Reason to analyze the findings. Analysis of results indicated the effectiveness of the surgical checklist in reducing the incidence of wrong-site surgeries and other medical errors; however, checklists alone will not prevent all errors. Successful implementation requires perioperative stakeholders to understand the nature of errors, recognize the complex dynamic between systems and individuals, and create a just culture that encourages a shared vision of patient safety.
Object:
Quality and safety are basic concerns in any medical practice. Especially in daily surgical practice, with increasing turnover and shortened procedure times, attention to these topics needs to be assured. Starting in 2007, the authors used a perioperative checklist in all elective procedures and extended the checklist in January 2011 according to the so-called team time-out principles, with additional assessment of patient identity and the planned surgical procedure performed immediately before skin incision, including the emergency cases.
Methods:
The advanced perioperative checklist includes parts for patient identification, preoperative assessments, team time-out, postoperative treatment, and imaging controls. All parts are signed by the responsible physician except for the team time-out, which is performed and signed by the theater nurse on behalf of the surgeon immediately before skin incision.
Results:
Between January 2007 and December 2010, 1 wrong-sided bur hole in an emergency case and 1 wrong-sided lumbar approach in an elective case (of 8795 surgical procedures) occurred in the authors' department. Using the advanced perioperative checklist including the team time-out principles, no error occurred in 3595 surgical procedures (January 2011-June 2012). In the authors' department all team members appreciate the chance to focus on the patient, the surgical procedure, and expected difficulties. The number of incomplete checklists and of patients not being transferred into the operating room was lowered significantly (p = 0.002) after implementing the advanced perioperative checklist.
Conclusions:
In the authors' daily experience, the advanced perioperative checklist developed according to the team time-out principles improves preoperative workup and the focus of the entire team. The focus is drawn to the procedure, expected difficulties of the surgery, and special needs in the treatment of the particular patient. Especially in emergency situations, the team time-out synchronizes the involved team members and helps to improve patient safety.
To determine whether ovariohysterectomy (OVH) required more time to complete and was associated with more short-term postoperative complications than ovariectomy (OVE) in dogs.
Randomized prospective clinical trial.
40 healthy, sexually intact female dogs.
OVH (in 20 dogs) or OVE (20 dogs) was performed by use of standardized anesthetic and surgical protocols. Physical characteristics of the dogs, surgical variables, pain scores derived from behavior-based composite pain scales, and surgical wound characteristics were analyzed.
Body weight, age, body condition score, and distance between the sternal manubrium and the pubic rim were comparable among dogs that underwent either surgical procedure. Body weight was positively correlated with the total duration of the procedure and with time required for closure of the surgical wound. No effect of body condition score was determined for any variable. Skin and fascia incision lengths relative to the distance from the sternal manubrium to pubic rim were significantly greater in dogs that underwent OVH, compared with those of dogs that underwent OVE, but total surgical time was not different for the 2 procedures. No other significant differences were detected between the 2 groups.
Significant differences in total surgical time, pain scores, and wound scores were not observed between dogs that underwent OVH and dogs that underwent OVE via standardized protocols.
Objective —To describe the clinical characteristics, treatment, complications, and outcome of dogs and cats treated surgically for major abdominal evisceration.
Design —Retrospective case series.
Animals —8 dogs and 4 cats.
Procedures —Medical records from January 1998 through March 2008 were reviewed to identify animals that underwent surgery for major abdominal evisceration. Data regarding cause of evisceration, signalment, physiologic variables, and hematologic variables were collected. Details of treatment, duration of hospitalization, and outcome were recorded. Linear regression analysis was performed to evaluate the association of signalment, physiologic variables, and hematologic variables on the number of days of hospitalization.
Results —Major abdominal evisceration was secondary to a traumatic event in 4 animals and to postsurgical dehiscence in 8 animals. All animals had evisceration of the intestines and gross contamination with dirt, leaves, or litter. Two animals eviscerated the spleen, and 1 animal had a perforated colon and was leaking feces into the peritoneal cavity. All animals underwent exploratory abdominal surgery. Surgical procedures performed included resection of compromised intestine, body wall repair, diaphragmatic hernia repair, nephrectomy, splenectomy, and primary colonic repair. All animals survived to discharge from the hospital. Median duration of hospitalization was 4 days (range, 1 to 7 days). Factors associated with an increase in duration of hospitalization included evisceration secondary to trauma, high lactate concentration at time of admission, and small body size.
Conclusions and Clinical Relevance —Despite the dramatic appearance of major abdominal evisceration in cats and dogs, prompt and aggressive medical and surgical intervention can provide a favorable outcome.
The College of Veterinary Medicine and Biomedical Sciences (CVMBS) at Texas A&M University (TAMU) has developed a multifaceted program in partnership with the Brazos Animal Shelter to provide teaching opportunities with shelter animals during all four years of the professional curriculum. In the first three semesters of the professional program, students working in small groups spend two hours per semester at the shelter performing physical examinations, administering vaccinations and anthelmintics, completing heartworm or FeLV/FIV testing, and performing simple medical treatments. In an expanded fourth-year program, groups of six students spend 16 contact hours at the shelter during two-week rotations, completing similar tasks. Through this program, each student practices animal-handling skills and routine procedures on an average of 150 to 200 dogs and cats. In addition, during third- and fourth-year surgery courses, student teams spay or neuter an average of 12 to 18 dogs or cats each week. More than 800 animals are spayed/neutered annually through this program, and each student directly participates in 12 to 15 spay/neuter survival surgeries. The program represents a creative approach to veterinary training that conscientiously uses animal resources in a positive fashion. We believe that this is a successful partnership between a state-supported veterinary college and a non-profit shelter that benefits both agencies. We encourage other veterinary colleges to explore similar partnership opportunities to provide optimal training for professional students while using animal resources efficiently.
The paper describes in detail the operative hazards and post–operative complications of ovariohysterectomy and indicates how they may be treated and possibly avoided.Résumé. La communication décrit en détail les risques opératoires et les complications postopératoires d'ovariotomie et d'hysterectomie, et indique comment on peut les traiter et probablement les éviter.Zusammenfassung. Ein Bericht der in Einzelheit die operativen Gefahren und postopera-tiven Komplikationen von einer Overiohysterektomie beschreibt und hinweist wie man sie behandelt und moglicherweise vermeidet.
Managing bleeding disorders (Proceedings)
- U Giger