Veterinary surgery : VS · 2004
Factors associated with mortality and morbidity in small intestinal volvulus in horses.
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Stephen Jennifer O, Corley Kevin T T, Johnston Janet K, Pfeiffer Dirk
Аннотация
OBJECTIVE: To determine historical, physical, and clinical factors that may affect morbidity and mortality in horses with small intestinal volvulus unrelated to other causes (e.g., incarceration, lipoma, etc.).
STUDY DESIGN: Retrospective study.
ANIMALS: Client-owned horses (115), aged 1 month to 21 years.
METHODS: Data were obtained from medical records, identified by computer search and manual review. Continuous variables were compared between affected and non-affected horses with Mann-Whitney U-tests and non-continuous variables with Fisher's exact test (2 x 2 tables) or chi(2)-tests (larger tables). Stepwise logistic regression analysis was used to develop a multivariable model of the risk factors, taking account of confounding and interaction.
RESULTS: Eighty percent of horses recovered from surgery survived to hospital discharge. Neither age, breed, nor sex was related to mortality. Survivors had a significantly lower heart rate, shorter capillary refill time, and better mucous membrane color. Variables associated with worsening cardiovascular status, increased hemoconcentration, and exudation of cells and protein into peritoneal fluid were significantly associated with non-survival. After recovery from surgery, the most serious complication was colic, which was significantly associated with non-survival (P=.028) as was a second celiotomy (P<.01). Both of these complications were associated with a jejunocecostomy during the first surgery.
CONCLUSIONS: Significant differences in the clinical and clinicopathologic signs were identified between survivors and non-survivors.
CLINICAL RELEVANCE: These findings can be used to make a scientific assessment of prognosis in the pre-operative, operative, and post-operative management of horses with small intestinal volvulus.
STUDY DESIGN: Retrospective study.
ANIMALS: Client-owned horses (115), aged 1 month to 21 years.
METHODS: Data were obtained from medical records, identified by computer search and manual review. Continuous variables were compared between affected and non-affected horses with Mann-Whitney U-tests and non-continuous variables with Fisher's exact test (2 x 2 tables) or chi(2)-tests (larger tables). Stepwise logistic regression analysis was used to develop a multivariable model of the risk factors, taking account of confounding and interaction.
RESULTS: Eighty percent of horses recovered from surgery survived to hospital discharge. Neither age, breed, nor sex was related to mortality. Survivors had a significantly lower heart rate, shorter capillary refill time, and better mucous membrane color. Variables associated with worsening cardiovascular status, increased hemoconcentration, and exudation of cells and protein into peritoneal fluid were significantly associated with non-survival. After recovery from surgery, the most serious complication was colic, which was significantly associated with non-survival (P=.028) as was a second celiotomy (P<.01). Both of these complications were associated with a jejunocecostomy during the first surgery.
CONCLUSIONS: Significant differences in the clinical and clinicopathologic signs were identified between survivors and non-survivors.
CLINICAL RELEVANCE: These findings can be used to make a scientific assessment of prognosis in the pre-operative, operative, and post-operative management of horses with small intestinal volvulus.