Incidence of and risk factors for surgical site infection following canine limb amputation

Abstract

Objective: To determine the incidence of and risk factors for surgical site infection (SSI) following canine thoracic and pelvic limb amputations.Study design: Retrospective, multicenter study. Animals: Dogs (n = 248).Methods: Medical records were reviewed for preoperative, intraoperative, and postoperative variables including indication for amputation, amputation type, method of muscle transection, duration of surgery and anesthesia, and wound classification. Follow up was ≥30 days or until SSI development. Logistic regression and Fisher's exact tests were used to compare SSI incidence to variables of interest.Results: The incidence of SSI was 12.5% for all procedures and 10.9% for clean procedures. Factors increasing odds of SSI were muscle transection with a bipolar vessel sealing device (P = .023 for all procedures, P = .025 for clean procedures), procedure classified as other than clean (P = .003), and indication for amputation of bacterial infection (P = .041) or traumatic injury (P = .003) compared to neoplasia. Conclusion:Use of bipolar vessel sealing devices for muscle transection increased the odds of developing an SSI whereas use of electrosurgery and/or sharp transection did not. Dogs with surgical sites that were other than clean, or with bacterial infection and/or traumatic injury were also at increased odds of SSI.Clinical significance: Use of electrosurgery or sharp transection for muscle transection should be considered rather than use of bipolar vessel sealing devices to decrease odds of SSI in dogs undergoing limb amputation. Further studies across a variety of procedures are needed to validate these findings given the increasing popularity of these devices in veterinary medicine. | INTRODUCTIONThoracic and pelvic limb amputations are commonly performed in dogs for neoplasia, orthopedic injuries, severe soft tissue trauma, neurologic diseases, unresolvable infections, congenital deformities, and vascular compromise. 1,2 The most common postoperative complications following limb amputations include

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“…Both the overall SSC and SSI rates fall within prior reported complication rates, dogs that were administered LB had more complications than those that did not. Surgical site infection rates after limb amputations were reported as 13/31 with LB, and 63/217 without LB; however, other factors (such as use of a vessel sealing device and the presence of infection and/or trauma) contributed to the SSI in this study 14 . Local macroscopic complications, such as redness and swelling, have been described for a different formulation of LB that was administered at higher doses; however, the authors attributed these signs to injection trauma 8 .…”

“…Surgical site infection rates after limb amputations were reported as 13/31 with LB, and 63/217 without LB; however, other factors (such as use of a vessel sealing device and the presence of infection and/or trauma) contributed to the SSI in this study. 14 Local macroscopic complications, such as redness and swelling, have been described for a different formulation of LB that was administered at higher doses; however, the authors attributed these signs to injection trauma. 8 A similar finding of redness in the immediate postoperative was reported in the majority of dogs receiving LB in a recent prospective study, 12 and the high number was attributed to the strict inclusion criteria for postoperative complications.…”

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“…14 Regarding amputation, a large series of 248 dogs was recently published investigating the method of muscle transection on the incidence of SSIs. 15 Overall, the SSI rate was 9.5% in dogs requiring an amputation for neoplasia, and another 23.5% developed other complications. In the latter group, the indication for amputation was unclear making it difficult to fully discern the overall rate of complications for patients with neoplasia.…”

“…For example, in a study describing a modified lateral approach to the cervical spine in 16 dogs for compressive myelopathy (which approximates the techniques used in MPNST dogs), intraoperative complications were reported in 18.8% ( n = 3; mild to moderate haemorrhage and incorrect site localization) and postoperative complications in 6.3% ( n = 1; disseminated intravascular coagulation) 14 . Regarding amputation, a large series of 248 dogs was recently published investigating the method of muscle transection on the incidence of SSIs 15 . Overall, the SSI rate was 9.5% in dogs requiring an amputation for neoplasia, and another 23.5% developed other complications.…”