title: The confidential enquiry into perioperative equine fatalities (CEPEF): mortality results of Phases 1 and 2.
abstract: OBJECTIVE
  To document the equine perioperative mortality rate and to highlight any factor associated with an increased risk of death up to 7 days after anaesthesia.
  
  
  METHODS
  A prospective observational epidemiological multicentre study.
  
  
  METHODS
  Data were recorded from all equidae undergoing general anaesthesia in 62 clinics. Power calculations indicated that 45 000 cases were required to detect the significance of important variables. Details of each horse, operation, anaesthetic agents and clinic personnel were recorded. Outcome at 7 days was recorded as: alive, put to sleep (PTS) or dead. Data were analysed by a standard multilevel logistic regression approach, considering the effects of clustering at the level of clinic.
  
  
  RESULTS
  Data were collected from 41 824 cases over 6 years. A total of 39 025 (93.3%) were alive on day 7 and 785 were dead giving an overall death rate of 1.9% (95% CI: 1.8-2.0) and 2014 (4.8%) were PTS. About 5846 horses undergoing emergency abdominal surgeries ('colics') were excluded from subsequent analyses. A total of 35 107 'noncolic' horses were alive at 7 days and 328 dead giving a death rate for noncolics of 0.9% (95% CI: 0.8-1.0). Five hundred and forty-three (1.5%) noncolic horses classified PTS were excluded from further analyses. There were 109 (33%) deaths from cardiac arrest or post-operative cardiovascular collapse, with 107 (32%) from fractures and myopathies. Fracture repair, out of hours surgery, and age below 1 month was associated with increased risk of dying whereas the use of acepromazine and intravenous anaesthetic agent maintenance of anaesthesia was associated with reduced risk.
  
  
  CONCLUSIONS
  A number of potential contributors to the high risk of anaesthetic-related mortality have been identified. Further investigation of the underlying mechanism for their apparent harmful effects and development of alternative techniques is merited.
authors.affiliation: Department of Clinical Veterinary Medicine, University of Cambridge, Cambridge, UK.
authors.forename: G M
authors.initials: GM
authors.lastname: Johnston
authors.affiliation: Epidemiology Unit, The Animal Health Trust, Newmarket, UK.
authors.forename: J K
authors.initials: JK
authors.lastname: Eastment
authors.affiliation: Epidemiology Unit, The Animal Health Trust, Newmarket, UK.
authors.forename: Jln
authors.initials: J
authors.lastname: Wood
authors.affiliation: Department of Clinical Veterinary Medicine, University of Cambridge, Cambridge, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Taylor
keywords: anaesthesia; epidemiology; horse; perioperative death; risk