Postoperative complications in equine elective, clean orthopaedic surgery with/without antibiotic prophylaxis

Abstract

Summary Objective: Retrospective analysis of postoperative complications in equines after clean, orthopaedic surgical procedures in order to detect differences between animals treated with antibiotics and horses without receiving these drugs. Material and methods: Details on 652 patients, surgical procedures and surgery-associated complications were compiled from horses being operated between June 2011 and January 2015. Antibiotic-receiving patients (n = 259) were tested for differences in complication rates and characteristics to controls (n = 393). Results: The total complication rate was 39.1 %. Increased swelling was observed most often (25.6 %), followed by exudation (7.5 %), fever without incisional alterations (2.3 %), suture dehiscence (1.8 %), and seroma (0.8 %). Seven patients (five treated, two controls) developed septic arthritis within a total of 463 arthroscopies (1.5 %). There were no significant differences in the development of postoperative complications, which were seen in 97/259 (37.5 %) antibiotic receiving patients and in 158/393 (40.2 %) controls. The application of perioperative antibiotics was significantly influenced by surgeon (p < 0.0001) and type of surgery (p = 0.0007) and increased with the number of surgical lesions (p = 0.03). In patients undergoing tendovaginoscopy/ bursoscopy, fasciotomy and neurectomy (n = 98), antibiotic prophylaxis was initiated less frequently than in other surgeries, e. g. combinations of surgeries, splint bone extraction, tenotomy, and arthroscopy (n = 554). Conclusion: Severe complications in equine clean orthopaedic surgery are rare and complication rates in patients either receiving perioperative antibiotics or not were not significantly different. Clinical relevance: Based on the results the use of antibiotics appears to be non-essential in uncomplicated elective orthopaedic interventions in the horse.

Usefulness of Selected Acute-Phase Proteins in the Postsurgical Monitoring of Arthroscopy and Splint Bone Removal in Horses

“…In splint bone removal, complications occur rarely and include: infection of the subcutaneous tissue; periosteal proliferative changes; and exuberant callus, which may affect the suspensory ligament [36]. In spite of preserving aseptic conditions during surgery and the experience of the surgeons, complications occurred in 6% (swelling and exudation was excluded) of the cases undergoing arthroscopy [2]. In the current study, a complication was detected (patient A27) in one case (2.44%) based on clinical signs and the APPs' measurements.…”

“…An elevated risk of surgical site infection [1] occurs during arthroscopic removal of large osteochondral fragments and may lead to septic arthritis. The risk of postoperative complications after clean orthopedic surgery [2] as well as joint infection after arthroscopy [3] is comparable when no antimicrobials or pre-/perioperative antimicrobial therapy has been applied. In horses, the APR is manifested in a variety of physiological processes in conditions of excessive stress induced by transport and physical exercise, and this emphasizes the role of APP as an important biomarker in horses [4][5][6].…”

Surgical antimicrobial prophylaxis: Current standards of care

“…Of note, in the latter study by Olds et al (2007), there was no significant difference in synovial sepsis incidence between horses receiving and not receiving SAP. Horses undergoing a variety of elective, clean orthopaedic surgical procedures (arthroscopy, fasciotomy, splint bone removal, tenotomy, neurectomy, tenoscopy/bursoscopy or a combination) had an overall complication rate of 39% (255/652) with complications not being significantly different between horses receiving SAP (97/259, 38%) and not receiving SAP (159/393, 40%, Stöckle et al, 2018). In the latter study, 2.5% (5/198) of horses receiving SAP and 0.7% (2/265) of horses not receiving SAP developed septic arthritis.…”

Retrospective evaluation of association between perioperative antimicrobial protocol and complications following elective equine synovial endoscopy

“…(Borg & Carmalt, 2013) No evidence across human or veterinary medicine supports the use of antimicrobial prophylaxis in clean, clean-contaminated or contaminated procedures beyond the perioperative period. (Borg & Carmalt, 2013;Bratzler et al, 2013;Brunsting et al, 2018;Southwood, 2014;Stockle et al, 2018) However, despite the previously reported low rate of septic synovitis following elective arthroscopy and the fact that Gram-positive bacteria are most commonly isolated in cases of septic synovitis, (Brunsting et al, 2018) equine surgeons often use empiric broad-spectrum antimicrobial therapy, at times with prolonged post-operative administration. (Muntwyler et al, 2020) Variability in antimicrobial regimes reflects the overall lack of usage guidelines in horses for specific procedures, suggesting that clinician preference and previous training strongly affect practices.…”