Factors affecting long-term survival of horses recovering from surgery of the small intestine.
BACKGROUND
Epiploic foramen entrapment (EFE) has been associated with a particularly poor post operative prognosis for equine colic cases, but the reasons for this are unknown.


OBJECTIVE
To identify variables associated with post operative survival following surgery for small intestinal disease; develop a model describing long-term post operative survival; and identify reasons for the poor prognosis associated with EFE.


METHODS
Data from 382 horses undergoing surgery were used to identify variables associated with survival. A multivariable Cox proportional hazards model for post operative survival was developed and model fit evaluated.


RESULTS
The final model included the variables total plasma protein (TP) and packed cell volume (PCV) at admission, duration of surgery and the dichotomous variable relaparotomy (yes/no). Risk of death was positively associated with increasing PCV, but negatively associated with increasing TP (which decreased the probability of death). In a univariable model, EFE cases had a significantly higher death rate than other types of small intestinal disease (hazard ratio = 1.7, P = 0.035). Multivariable modelling indicated that some of the increased risk associated with EFE cases was due to lower TP values and longer duration of surgery.


CONCLUSIONS
Preoperative TP is associated negatively with the risk of post operative death in horses recovering from small intestinal surgery. Other variables associated with the probability of survival are preoperative PCV, duration of surgery and relaparotomy. The increased post operative death rate of EFE cases can be explained in part by lower TP and longer surgery times of these cases.


CONCLUSIONS
Total plasma protein may be not simply a measure of hydration status in small intestinal colic cases, but an important determinant of survival. Further investigation of this relationship is warranted. Our model for post operative survival highlights the importance of preoperative TP, PCV and duration of surgery as prognostic indicators. This information should allow a more accurate post operative prognosis following small intestinal surgery.
Proudman
C J
CJ
Faculty of Veterinary Science, University of Liverpool, Leahurst, Neston, Wirral CH64 7TE, UK.
Edwards
G B
GB
Barnes
J
J
French
N R
NR
D000818:Animals; D001798:Blood Proteins / Q000032:analysis; D003085:Colic / Q000401:mortality / Q000601:surgery / Q000662:veterinary*; D005260:Female; D006400:Hematocrit / Q000401:mortality / Q000662:veterinary; D006734:Horse Diseases / Q000401:mortality* / Q000601:surgery*; D006736:Horses; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000662:veterinary*; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation / Q000401:mortality / Q000662:veterinary; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
D001798:Blood Proteins