Effects of age, disease and anastomosis on short‐ and long‐term survival after surgical correction of small intestinal strangulating diseases in 89 horses

Abstract

Summary Background Although survival rates have been reported after small intestinal surgery for strangulating diseases in horses, none have followed survival for periods relevant to the long lifespan of horses and none have described effect of age, disease and surgical treatments over such long survival periods. Objectives To examine effects of age, disease and type of surgery on long‐term survival in horses after surgical treatment of small intestinal strangulating diseases over periods relevant to the expected lifespan of a horse. Study Design Retrospective clinical study. Methods Post‐operative data were gathered from medical records and owner contact for 89 horses with small intestinal strangulation. Survival times from surgery to the date of death or the date of last follow‐up were analysed by Kaplan‐Meier statistics. Variables of interest were age, type of strangulating disease and surgical correction. Cox proportional hazards regression was used to evaluate these variables. Results Short‐term survival was not affected by any of the variables measured. For long‐term survival with Kaplan‐Meier statistics, horses ≥16 years old had significantly shorter (P = .002) median survival times (72 months; 95% CI 32.0‐96.0) than younger horses (121.7 months; 95% CI 90.0‐162), horses without resection had significantly longer (P = .02) survival times (120 months; 95% CI 86‐212) than horses that had jejunocecostomy (76.8 months; 95% CI 24‐125), and horses with miscellaneous diseases had significantly longer (P = .02) median survival times (161.9 months; 95% CI 72.0‐M) than horses with strangulating lipoma (79.8 months; 95% CI 32.0‐120.0). In the multivariable Cox Proportional Hazard model, age (HR = 2.67; 1.49‐4.75, P < .001) and anastomosis (HR = 0.65; 0.46‐0.92, P = .02) had the most significant effect on median survival time. Main Limitations Limitations were small numbers in some categories, loss of cases to follow‐up, owner recall failures and lack of a control group. Conclusions The remaining lifespan of older horses at the time of surgery had the greatest effect on survival. Age could influence long‐term survival studies after colic surgery, and therefore needs to be considered for survival analyses. Horses that did not require resection and anastomosis had favourable outcomes, underscoring the potential importance of early intervention to reduce the need for resection.

Use of a new device for inversion of the necrotic ileal stump in the caecum in four horses

“…When strangulating lesions involve the aborad ileum, jejunocaecostomy may be necessary to restore intestinal continuity. In some studies, this procedure has been comparable to others in terms of short‐ and long‐term survival 1,2 with short‐term survival of up to 83% or even 91% for a single, 2 experienced surgeon 3 . Others have reported a higher complication rate compared with jejunojejunostomy 4,5 …”

Highlights of recent clinically relevant papers

“…This retrospective clinical study by Meredith Rudnick and co‐workers at the University of Florida, USA, examined the effects of age, disease and type of surgery on long‐term survival in horses after surgical treatment of small intestinal strangulating diseases over periods relevant to the expected lifespan of a horse .…”

Multi-Institutional Retrospective Case-Control Study Evaluating Clinical Outcomes of Foals with Small Intestinal Strangulating Obstruction: 2000–2020

“…Colic is the leading cause of death in adult horses, accounting for over 30% of deaths in horses from 1- to 20-years-of-age [ 1 , 2 , 3 ]. The most fatal form of colic in adult horses is strangulating obstruction [ 4 ], including strangulating lipomas of the small intestine where the reported mean age of affected horses is 19.2 years, and epiploic foramen entrapment of the small intestine where the reported mean age of affected horses is 9.6 years of age [ 5 ]. Reported rates of short-term survival from surgery to hospital discharge for these diseases range from 50–80% [ 5 ].…”