Veterinary surgery : VS · 2022
Outcomes of dogs undergoing surgery for gastric dilatation volvulus after rapid versus prolonged medical stabilization.
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Lhuillery Eloïse, Velay Ludivine, Libermann Stéphane, Le Boedec Kevin, Gautherot Audrey, Bonneau Lucie, Mongellas Emilie, Harris Karen, Etchepareborde Sébastien
Аннотация
OBJECTIVE: To compare the outcomes of dogs surgically treated for gastric dilatation volvulus (GDV) after rapid versus prolonged medical stabilization.
STUDY DESIGN: Prospective cohort study, monoinstitutional.
SAMPLE POPULATION: One hundred and sixty-two dogs with GDV.
METHODS: Dogs presenting with a GDV were allocated to 1 of 2 groups, immediate or delayed. In the immediate group, dogs were stabilized for 90 min prior to undergoing surgery. In the delayed group, dogs underwent surgery after at least 5 h of stabilization. Medical stabilization included gastric decompression and placement of an indwelling nasogastric tube to prevent further gastric dilatation in all dogs. Short-term outcomes were compared between surgical timings by univariate and multivariate analyses.
RESULTS: Dogs (n = 89) in the immediate group underwent surgery a median time of 2.1 h after presentation (range 1.9-2.5 h), whereas those in the delayed surgery group (n = 73) were operated a median time of 9.8 h (range 5.4-13.7 h) after presentation. Survival rates did not differ between dogs undergoing immediate or delayed surgery at discharge (70/89 and 60/73, respectively) or at 1 month postoperatively (68/89 and 55/73, respectively). The degree of gastric torsion was differently distributed between the 2 groups (P = .05). In the immediate group, 19, 52, and 9 dogs had a 0°, 180° and 270° gastric torsion respectively, whereas in the delayed group, 27, 32, and 5 dogs had a 0°, 180° and 270° gastric torsion respectively. Hyperlactatemia 24 h after initiation of fluid therapy was associated with an increased in-hospital mortality risk and at 1 month postoperatively.
CONCLUSION: No survival benefit was detected as a result of proceeding to surgery after either a rapid or a prolonged medical stabilization.
CLINICAL SIGNIFICANCE: The aggressive stabilization and monitoring protocol described here can be considered as an alternative to stabilize dogs with GDV prior to surgery within 13.7 h of presentation. Further research is required to investigate the potential risks and benefits of prolonged over rapid stabilization and to identify candidates for each approach.
STUDY DESIGN: Prospective cohort study, monoinstitutional.
SAMPLE POPULATION: One hundred and sixty-two dogs with GDV.
METHODS: Dogs presenting with a GDV were allocated to 1 of 2 groups, immediate or delayed. In the immediate group, dogs were stabilized for 90 min prior to undergoing surgery. In the delayed group, dogs underwent surgery after at least 5 h of stabilization. Medical stabilization included gastric decompression and placement of an indwelling nasogastric tube to prevent further gastric dilatation in all dogs. Short-term outcomes were compared between surgical timings by univariate and multivariate analyses.
RESULTS: Dogs (n = 89) in the immediate group underwent surgery a median time of 2.1 h after presentation (range 1.9-2.5 h), whereas those in the delayed surgery group (n = 73) were operated a median time of 9.8 h (range 5.4-13.7 h) after presentation. Survival rates did not differ between dogs undergoing immediate or delayed surgery at discharge (70/89 and 60/73, respectively) or at 1 month postoperatively (68/89 and 55/73, respectively). The degree of gastric torsion was differently distributed between the 2 groups (P = .05). In the immediate group, 19, 52, and 9 dogs had a 0°, 180° and 270° gastric torsion respectively, whereas in the delayed group, 27, 32, and 5 dogs had a 0°, 180° and 270° gastric torsion respectively. Hyperlactatemia 24 h after initiation of fluid therapy was associated with an increased in-hospital mortality risk and at 1 month postoperatively.
CONCLUSION: No survival benefit was detected as a result of proceeding to surgery after either a rapid or a prolonged medical stabilization.
CLINICAL SIGNIFICANCE: The aggressive stabilization and monitoring protocol described here can be considered as an alternative to stabilize dogs with GDV prior to surgery within 13.7 h of presentation. Further research is required to investigate the potential risks and benefits of prolonged over rapid stabilization and to identify candidates for each approach.