The Confidential Enquiry into Perioperative Equine Fatalities: phase 4 (CEPEF4) – a worldwide observational, prospective, multicentre cohort study in 2025

IF 1.9 2区农林科学 Q2 VETERINARY SCIENCES

Veterinary anaesthesia and analgesia Pub Date : 2025-06-16 DOI:10.1016/j.vaa.2025.06.005

Miguel Gozalo-Marcilla , José I. Redondo , Regula Bettschart-Wolfensberger , Luis Domenech , Javier Doménech , G Mark Johnston , Polly M. Taylor

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引用次数: 0

Abstract

Objective

To report on the Confidential Enquiry into Perioperative Equine Fatalities 4 (CEPEF4).

Study design

Confidential, observational, prospective, multicentre, cohort study.

Animals

47,396 horses/ponies undergoing general anaesthesia (GA).

Methods

Characteristics of each GA (249 variables) were collected. Outcomes after seven days were ALIVE (or discharged), EUTHANASIA or DEAD. Logistic regression analysed patient demographics and the anaesthetic drugs (p < 0.05).

Results

Data were collected from 47,396 GAs in 93 centres in 28 countries. Death rates were 1.2% overall, 0.6% for cases classified as NON-COLIC and 4.2% for COLIC. For NON-COLICs (227 deaths from 39,798 NON-COLICs), the main three causes of death were fractures (35.7%), abdominal complications (18.1%) and central nervous system problems (13.2%). Logistic regression analyses revealed an increase in the odds of death for pregnant mares, geriatrics, thin horses, those with a higher American Society of Anesthesiologists grade, urgent procedures and those lasting < 1 hour or > 2 hours. Ketamine infusions and plasma lactate measurement during maintenance were associated with elevated risk. By contrast, monitoring invasive arterial pressure, end-tidal CO₂, blood gases and body temperature were each associated with reduced odds of death. Premedication with agonist-antagonist/partial-agonist opioids with non-steroidal anti-inflammatory drugs and administration of α₂-adrenoceptor agonists during recovery, alone or with acepromazine, were associated with reduced odds of death.

Conclusions and clinical relevance

CEPEF4 reports a reduction in the death rate compared with CEPEF2 in 2002: overall 1.2% versus 1.9%, colic death rate 4.2% versus 7.8% and non-colic death rate 0.6% versus 0.9%. Healthy horses still die, the majority because of fractures during recovery. We identified factors that may influence clinical decision-making and enhance patient safety. The CEPEF4 database will continue to provide clinically applicable information, with potential for further insights and improvements in equine anaesthesia.

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马围手术期死亡保密调查：4期（CEPEF4）——2025年的一项全球观察性、前瞻性、多中心队列研究。

目的：报道马围手术期死亡4 （CEPEF4）的保密调查。研究设计：保密、观察、前瞻性、多中心、队列研究。动物：47,396匹接受全身麻醉的马/小马。方法：收集每个GA（249个变量）的特征。7天后的结果是活着（或出院）、安乐死或死亡。Logistic回归分析患者人口统计学和麻醉药物（p < 0.05）。结果：从28个国家93个中心的47,396个GAs收集数据。总体死亡率为1.2%，非绞痛病例死亡率为0.6%，绞痛病例死亡率为4.2%。对于非绞痛患者（39,798例非绞痛患者中有227例死亡），主要的三个死亡原因是骨折（35.7%）、腹部并发症（18.1%）和中枢神经系统问题（13.2%）。逻辑回归分析显示，怀孕母马、老年马、瘦马、美国麻醉医师协会较高等级的马、紧急手术和持续时间< 1小时或≤2小时的马的死亡几率增加。维持期间氯胺酮输注和血浆乳酸测量与风险升高相关。相比之下，监测侵入性动脉压、潮末二氧化碳、血气和体温都与降低死亡几率有关。术前使用激动剂-拮抗剂/部分激动剂阿片类药物联合非甾体抗炎药，康复期间单独或联合使用α - 2肾上腺素受体激动剂可降低死亡几率。结论和临床意义：与2002年的CEPEF4相比，CEPEF4报告的死亡率降低：总体死亡率为1.2%对1.9%，绞痛死亡率为4.2%对7.8%，非绞痛死亡率为0.6%对0.9%。健康的马仍然会死亡，大多数是因为在恢复过程中骨折。我们确定了可能影响临床决策和提高患者安全的因素。CEPEF4数据库将继续提供临床应用信息，具有进一步了解和改进马麻醉的潜力。

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来源期刊

Veterinary anaesthesia and analgesia 农林科学-兽医学

CiteScore

3.10

自引率

17.60%

发文量

审稿时长

97 days

期刊介绍： Veterinary Anaesthesia and Analgesia is the official journal of the Association of Veterinary Anaesthetists, the American College of Veterinary Anesthesia and Analgesia and the European College of Veterinary Anaesthesia and Analgesia. Its purpose is the publication of original, peer reviewed articles covering all branches of anaesthesia and the relief of pain in animals. Articles concerned with the following subjects related to anaesthesia and analgesia are also welcome: the basic sciences; pathophysiology of disease as it relates to anaesthetic management equipment intensive care chemical restraint of animals including laboratory animals, wildlife and exotic animals welfare issues associated with pain and distress education in veterinary anaesthesia and analgesia. Review articles, special articles, and historical notes will also be published, along with editorials, case reports in the form of letters to the editor, and book reviews. There is also an active correspondence section.