Use of perioperative variables to determine the requirement for repeat celiotomy in horses with postoperative reflux after small intestinal surgery.

Abstract

OBJECTIVE To determine whether perioperative variables can be used to differentiate a medical vs a surgical reason for postoperative reflux (POR) after small intestinal (SI) surgery in horses. STUDY DESIGN Retrospective study. SAMPLE POPULATION Horses >1 year of age that recovered from SI surgery and had POR. METHODS Medical records of horses that underwent SI surgery and developed POR from 2009-2015 were reviewed. Surgical reasons for POR were defined as an anastomosis complication, mechanical obstruction, or nonviable intestine identified at repeat celiotomy/necropsy. A medical reason for POR was presumed when the POR improved with medical treatment or when no surgical reasons were identified at repeat celiotomy/necropsy. Perioperative variables were analyzed and used to develop a logistic regression model. RESULTS Fifty-one horses had POR after SI surgery. After initial SI surgery, 14 horses had surgical reasons for POR diagnosed at repeat celiotomy or necropsy. Thirty-seven horses were considered to have medical reasons for POR because their POR resolved with medical management or functional ileus was diagnosed at repeat celiotomy/necropsy. A greater volume and a greater duration of POR were not associated with a surgical reason for POR. Rather, a postoperative (PO) fever and the timing of colic in the PO period were associated with a surgical reason for POR. CONCLUSION Horses that developed a fever and colic in the PO period after SI surgery were more likely to have a surgical reason for POR. CLINICAL SIGNIFICANCE These findings may provide guidance for clinicians when they are making decisions about repeat celiotomy in horses with POR after SI surgery.