title: Risk factors for incisional complications after exploratory celiotomy in horses: do skin staples increase the risk?
abstract: OBJECTIVE
  To assess risk factors for celiotomy incisional infection in horses, especially the use of staples for skin closure.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Horses (n=356) that had 1 exploratory celiotomy for colic and survived >2 weeks after surgery between March 1, 2004 and December 31, 2007.
  
  
  METHODS
  Incisions were classified as "normal" (no complication, only edema, serous drainage lasting <24 hours) or as "surgical site infection (SSI)" (persistent serosanguinous drainage or purulent drainage with or without positive bacterial culture). All possible risk factors, including method of skin closure (monofilament sutures or staples), were statistically analyzed using univariate and multivariate logistic regression.
  
  
  RESULTS
  Of 356 horses, 303 (85%) had normal wound healing and 53 (15%) developed a SSI (purulent: 48 [14%]; persistent serosanguinous: 5 [1%]). Bacterial cultures were positive in 33 of 40 cases. Factors significantly associated with SSI in the multivariate analysis were: use of staples for skin closure (odds ratio [OR] 3.85, P<.001) and surgical site closure by a 1st or 2nd year resident (OR 2.20, P=.016). Lavage of the linea alba with sterile saline solution after closure was a protective factor (OR 0.38, P=.004).
  
  
  CONCLUSIONS
  Use of staples for skin closure and less experienced surgeons closing the abdomen are risk factors for incisional infection. Incisional lavage after linea alba closure was a protective factor.
  
  
  CONCLUSIONS
  Despite their ease and speed of application, skin staples can lead to an increase in celiotomy wound complications in horses.
authors.affiliation: Department of Surgery and Anesthesiology of Domestic Animals; Large Animal Internal Medicine; Reproduction, Obstetrics and Herd Health; and Unit for Veterinary Epidemiology, Ghent University, Ghent, Belgium. sara.torfs@ugent.be
authors.forename: Sara
authors.initials: S
authors.lastname: Torfs
authors.forename: Tamara
authors.initials: T
authors.lastname: Levet
authors.forename: Catherine
authors.initials: C
authors.lastname: Delesalle
authors.forename: Jeroen
authors.initials: J
authors.lastname: Dewulf
authors.forename: Lieven
authors.initials: L
authors.lastname: Vlaminck
authors.forename: Frederik
authors.initials: F
authors.lastname: Pille
authors.forename: Laurence
authors.initials: L
authors.lastname: Lefere
authors.forename: Ann
authors.initials: A
authors.lastname: Martens
mesh_terms: D015746:Abdominal Pain / Q000601:surgery / Q000662:veterinary; D000367:Age Factors; D000818:Animals; D005260:Female; D006734:Horse Diseases / Q000601:surgery*; D006736:Horses / Q000601:surgery; D007813:Laparotomy / Q000009:adverse effects / Q000662:veterinary*; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000662:veterinary*; D012307:Risk Factors; D012737:Sex Factors; D017792:Surgical Stapling / Q000009:adverse effects / Q000662:veterinary*; D013530:Surgical Wound Infection / Q000209:etiology / Q000662:veterinary