Complications, prognostic factors, and long-term outcomes for dogs with brachycephalic obstructive airway syndrome that underwent H-pharyngoplasty and ala-vestibuloplasty: 423 cases (2011–2017)

Abstract

OBJECTIVE To describe the H-pharyngoplasty procedure, report the outcomes of dogs with brachycephalic obstructive airway syndrome (BOAS) treated with ala-vestibuloplasty and H-pharyngoplasty with a CO2 laser, and identify prognostic factors. ANIMALS 423 dogs. PROCEDURES Medical records of dogs admitted for BOAS from 2011 to 2017 were reviewed. Dogs were included if they were treated with ala-vestibuloplasty and H-pharyngoplasty with a CO2 laser. Signalment, physical examination findings, grades at admission of clinical signs associated with respiratory and digestive systems, diagnostic test results, postoperative treatments, and short-term follow-up results were extracted from medical records. Long-term follow-up of > 12 months was evaluated via questionnaire. Generalized ordered logistic regression was used for bivariable and multivariable analyses. RESULTS Overall mortality rate was 2.6%. Median duration of follow-up was 36 months (12 to 91 months), and 341 (80.6%) dog owners completed the questionnaire. Major complications included respiratory distress (2.1%), heatstroke (0.5%), and bronchopneumonia (0.5%). No dogs required revision surgery. Improvement in signs associated with the respiratory and digestive systems was reported in 72% and 34% of the dogs, respectively, and owners’ satisfaction was high (97.1%). Risk of death increased by 29.8% (95% CI, 11.8% to 50.7%) for every 1-year increase in age. CONCLUSION AND CLINICAL RELEVANCE H-pharyngoplasty was possible in all dogs with BOAS, including those previously treated with conventional surgery and was associated with low morbidity and improved respiratory and digestive signs. H-pharyngoplasty combined with ala-vestibuloplasty may be an alternative treatment for even the most severely affected dogs.

A retrospective observational cohort study on the postoperative respiratory complications and their risk factors in brachycephalic dogs undergoing BOAS surgery: 199 cases (2019‐2021)

“…Aspiration pneumonia is a common complication in brachycephalic dogs due to their increased risk of regurgitation. The rate of postoperative aspiration pneumonia in the current study was similar to previously reported rates that ranged from 1% to 7% (Carabalona et al., 2022; Costa et al., 2020; Fenner et al., 2020; Lindsay et al., 2020; Stordalen et al., 2020). Although the association of BCS with the development of this complication was not maintained in the multivariable regression model, it is still reasonable to recommend weight loss to overweight dogs before proceeding to airway surgery despite previous reports suggesting a decrease in complication rates with increased bodyweight (Gruenheid et al., 2018).…”

“…The results of this study highlight the prevalence and risk factors of postoperative respiratory complications following multilevel BOAS surgery. The proportion of dogs experiencing at least one postoperative complication was 15% which falls within the range of previously reported rates (3.2% to 26%) (Carabalona et al., 2022; Fasanella et al., 2010; Poncet et al., 2006; Riecks et al., 2007). Airway obstruction is a potentially fatal complication following BOAS surgery.…”

“…Certain factors such as: further findings on CT ( e.g . presence of hypoplastic trachea) (Riecks et al., 2007), presence of hiatal hernia (Carabalona et al., 2022), degree of regurgitation before surgery and long‐term postoperatively (Poncet et al., 2006; Worth et al., 2018), the use and duration of positive‐pressure ventilation during anaesthesia (Doyle et al., 2020) and type of soft palate surgery (H‐plasty or folded flap palatoplasty) (Carabalona et al., 2022) were not recorded, but may still have confounded the results. In addition, the specific elements of BOAS surgery performed in each case varied which may have impacted the results.…”

Severity of nasopharyngeal collapse before and after corrective upper airway surgery in brachycephalic dogs

“…This suggests either that standard corrective surgery does not reduce upper airway resistance adequately to prevent collapse, or that there may be inadequate upper airway dilator muscle function in some brachycephalic dogs. Larger studies on the effect of traditional surgical correction, modified multilevel surgery, 64 and H‐pharyngoplasty surgery 68 on this condition are warranted.…”

Risk factors for complicated perioperative recovery in dogs undergoing staphylectomy or folded flap palatoplasty: Seventy‐six cases (2018–2022)

“…4,9 However, increasing age was a risk factor for death in a more recent study of 423 brachycephalic dogs undergoing BOAS surgery. 10 Brachycephalic dogs were reportedly four times more likely to experience postanesthetic complications compared to nonbrachycephalic dogs, and prolonged anesthesia was a risk factor for development of complications including aspiration pneumonia and need for temporary tracheostomy. 9,11 Also, young brachycephalic dogs with normal body condition and presence of laryngeal collapse undergoing traditional multilevel surgery for BOAS seemed to have less favorable postoperative prognosis.…”