Impact of intra‐operative hypotension on mortality rates and post‐operative complications in dogs undergoing cholecystectomy

Abstract

To report the mortality rate within a cohort of dogs undergoing cholecystectomy and investigate the impact of intra-operative hypotension on mortality. Materials and MethOds: Clinical records at five UK referral centres were reviewed for dogs undergoing cholecystectomy. Data collected included presenting signs, pre-operative blood test results, intra-operative data including frequency and duration of hypotension and the incidence and type of post-operative complications. results: Data from 119 dogs were included. Sixteen dogs (13%) died before discharge and by 28 days after surgery the total mortality was 19 dogs (17%). Hypotension lasting over 10 minutes during general anaesthesia occurred in 65 dogs (54.6%), with a mean ± sd duration of 36.1 ± 30.0 minutes. Intra-operative hypotension or the number of hypotensive episodes did not appear to be associated with in-hospital or 28-day mortality. American Society of Anaesthesiologists grade (of fitness for surgery) was significantly associated with both in-hospital and 28-day mortality on univariable analysis, as were post-operative hypoproteinaemia, ileus and pancreatitis. However on multivariable analysis, only ileus and pancreatitis were found to significantly impact mortality.

Ultrasonographic patterns, clinical findings, and prognostic variables in dogs from Asia with gallbladder mucocele

“…Firstly, clinically relevant hypotension is common in dogs undergoing cholecystectomy. Eighty‐six percent (67/78) of dogs in this study developed intraoperative hypotension, which is comparable to previous studies (55%‐74%) that evaluated intraoperative blood pressure in dogs undergoing cholecystectomy 18,21,23 . This is much higher than the 7% to 10% incidence reported in general small animal anesthesia 24,25 .…”

“…Firstly, clinically Eighty-six percent (67/78) of dogs in this study developed intraoperative hypotension, which is comparable to previous studies (55%-74%) that evaluated intraoperative blood pressure in dogs undergoing cholecystectomy. 18,21,23 This is much higher than the 7% to 10% incidence reported in general small animal anesthesia. 24,25 Reasons a dog might develop hypotension during anesthesia are often complex and multifactorial, but the high incidence during cholecystectomy indicates that biliary disease itself is contributory.…”

“…These results are in contrast to 2 recent retrospective studies that found no association between intraoperative hypotension and death in dogs undergoing cholecystectomy. 18 , 21 The dissimilar statistical interrogation of intraoperative blood pressure could explain the conflicting results. The aforementioned studies evaluated intraoperative blood pressure categorically (eg, hypotension [present/absent] and hypotension lasting >10 minutes [present/absent]).…”

“… 20 Hypotension was defined as an SBP of <90 mm Hg. 21 Dogs were considered to have hyperadrenocorticism, hypothyroidism, and diabetes mellitus based on published criteria. 6 Dogs were considered to be clinical or subclinical based on the presence or absence, respectively, of any signs of biliary tract disease within the 7 days preceding hospital admission: vomiting, diarrhea, lethargy, anorexia, hyporexia, abdominal pain or distension, jaundice, weakness, hypodipsia, adipsia, and fever.…”

“…Intraoperative SBP measurements were obtained via Doppler or oscillometric techniques in accordance with previously established guidelines 20 . Hypotension was defined as an SBP of <90 mm Hg 21 . Dogs were considered to have hyperadrenocorticism, hypothyroidism, and diabetes mellitus based on published criteria 6 .…”