Retrospective study of intra-anesthetic predictors of prolonged hospitalization, increased cost of care and mortality for canine patients at a veterinary teaching hospital

Smith, Melissa D.; Barletta, Michele; Young, Courtni N.; Hofmeister, Erik H.

doi:10.1016/j.vaa.2017.04.007

Cited by 16 publications

(16 citation statements)

References 19 publications

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“…When EB survivors and non-survivors were compared, ASA physical status was found to be lower in survivors. Increasing ASA physical status has repeatedly been associated with mortality [ 3 , 4 , 7 – 10 , 12 ] including one study specifically looking at brachycephalic breeds [ 2 ]. One possible reason that EB had higher mortality with lower ASA status is that many EB with moderate to severe BOAS have surgery to correct the airway defects early in life.…”

Section: Discussionmentioning

confidence: 99%

“…Due to these abnormalities, brachycephalic dogs were widely considered to have a greater risk of perianesthetic mortality [ 1 ]. Recently, Gruenheid et al [ 2 ] reported that brachycephalic dogs were more likely to experience perianesthetic complications compared with non-brachycephalic dogs, however brachycephaly is not a reported risk factor for perianesthetic mortality [ 3 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Perianesthetic mortality in English Bulldogs: a retrospective analysis in 2010 – 2017

et al. 2022

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Background Many veterinarians consider English Bulldogs to have a greater perianesthetic mortality risk. The aims of this study were to 1) determine total and anesthesia-related, perianesthetic mortality (PAM) rates in English Bulldogs (EB), 2) identify potential risk factors associated with mortality in EB, and 3) determine the difference in the perianesthetic mortality rates between EB, other-brachycephalic breeds (OB), and non-brachycephalic breeds (NB). Records from EB that were anesthetized between 2010 and 2017, were investigated. OB and NB were enrolled to match with each EB based on a procedure and age from the study period. Data collected in EB included: age, ASA status, weight, procedure types, anesthetic and analgesic management, anesthetic duration, anesthetic recovery location, and cause of death. Age and cause of death were determined from OB and NB. Fisher’s exact test was used to compare PAM rate and age in EB, OB, and NB. Mann–Whitney U test was used to compare EB survivor and EB non-survivor. Logistic regression models were used to identify factors and odds ratio (OR) associated with PAM in EB. Result Two hundred twenty nine EB, 218 OB, and 229 NB were identified. The total and anesthesia-related PAM rates in EB were 6.6 and 3.9%, respectively. EB had a greater total PAM rate compared with OB (p = 0.007). ASA status was different between survivors and non-survivors in EB (p < 0.01). Risk factors identified regardless of the cause of death were premedication with full μ opioids (OR = 0.333, p = 0.114), continuous infusion of ketamine post-operatively (OR = 13.775, p = 0.013), and acepromazine administration post-operatively (OR = 7.274, p = 0.004). The most common cause of death in EB was postoperative respiratory dysfunction (87.5%). Conclusion Total and anesthesia-related mortality in EB is considerable. Most deaths in EB occurred during the postoperative period secondary to respiratory complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perianesthetic mortality in English Bulldogs: a retrospective analysis in 2010 – 2017

et al. 2022

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“…Accordingly, in veterinary medicine, a study with 235 dogs undergoing general anesthesia indicated that the ASA PS status was the only factor associated with the duration of ICU care (the higher ASA PS, the longer ICU stay), which, in turn, was a feature associated with an increase in the cost of hospitalization ( 34 ). In addition, the ASA PS classification could identify an increased frequency and severity of perioperative complications in human patients ( 52 ), dogs and cats ( 21 , 22 ); a long ICU stay in dogs ( 34 ), and a poor recovery quality from anesthesia in horses ( 37 , 38 ). Dogs ASA III, IV and V, were 3.4, 7.1, and 18.8 times, respectively, more likely to develop severe perianesthetic complications than those ASA I-II ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

“…In veterinary medicine, to the authors' knowledge, one of the first prospective publications mentioning the association between the ASA PS classification and the anesthesia-related risk of death was from Clarke and Hall ( 19 ). Since then, several studies associating the ASA PS to anesthesia-related risk of death were published for dogs and cats ( 20 – 34 ), rabbits ( 24 , 35 ), pigs ( 36 ), and horses ( 37 , 38 ) with different outcomes and definitions. However, whether veterinary patients with a high ASA PS score are at an increased risk of death and development of complications associated with anesthesia remains unknown.…”

Section: Introductionmentioning

confidence: 99%

The ASA Physical Status Classification: What Is the Evidence for Recommending Its Use in Veterinary Anesthesia?—A Systematic Review

Portier

Ida

2018

Front. Vet. Sci.

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Background: The effectiveness of the American Society of Anesthesiologists (ASA) Physical Status (PS) classification to identify the animals at a greater risk of anesthesia-related death and complications is controversial. In this systematic review, we aimed to analyze studies associating the ASA PS scores with the outcome of anesthesia and to verify whether there was any evidence for recommending the use of the ASA PS in veterinary patients.Methods: Research articles found through a systematic literature search were assessed for eligibility, and data were extracted and analyzed using random-effects analysis.Results: A total of 15 observational prospective and retrospective studies including 258,298 dogs, cats, rabbits, and pigs were included. The analysis found consistency between the studies showing that dogs, cats and rabbits with an ASA-PS ≥III had 3.26 times (95% CI = 3.04–3.49), 4.83 times (95% CI = 3.10–7.53), and 11.31 times (95% CI = 2.70–47.39), respectively, the risk of anesthesia-related death within 24 h (dogs) and 72 h (cats and rabbits) after anesthesia compared with those with an ASA PS

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“…When surgery time was taken out of the equation, the median anesthesia time was 10 minutes longer in the EPID group than in the OBA group. It has recently been confirmed that a long operational duration is associated with complications, such as surgical site infection, venous thromboembolism, bleeding, hematoma formation, necrosis, and increased hospital charges, but not DOH or survival at discharge …”

Section: Discussionmentioning

confidence: 99%

Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: A retrospective study of 56 cases

2019

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Objective To compare perioperative opioid consumption and duration of hospitalization (DOH) in anesthetized dogs receiving opioid‐based analgesia (OBA) vs those receiving bupivacaine epidural‐based analgesia (EPID) during cystotomy. Study design Retrospective cross‐sectional study. Animals Fifty‐six client‐owned dogs undergoing cystotomy. Methods Clinical records of dogs undergoing cystotomy between January 2015 and December 2017 were reviewed. Demographic data, duration of anesthesia and surgery, anesthetic management, perioperative opioid consumption expressed in morphine equivalents (ME), perioperative use of adjuvant analgesics, time to first micturition, time to eat, time to ambulate, and DOH were recorded. Opioid consumption and DOH were compared with a Wilcoxon rank‐sum test, followed by linear regression analysis as appropriate. Time to first micturition, time to eat, and time to walk unassisted were modeled with Cox‐proportional hazard models. Results Dogs treated with EPID during surgery required 1.5 mg/kg ME less compared with those treated with OBA (P = .04) during surgery. Three of 19 dogs treated with EPID vs 15 of 37 dogs receiving OBA required intraoperative adjuvant analgesics (P = .06). Dogs treated with EPID regained motor function slower than dogs treated with OBA (P = .01); however, there was no difference in time to urinate, time to eat, or DOH between treatments. Conclusion Perioperative lumbosacral epidural with bupivacaine reduced intraoperative opioid consumption in dogs anesthetized for cystotomy. Clinical significance The use of epidural bupivacaine in dogs undergoing cystotomy may reduce intraoperative opioid requirements without affecting return of bladder function or DOH.

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Retrospective study of intra-anesthetic predictors of prolonged hospitalization, increased cost of care and mortality for canine patients at a veterinary teaching hospital

Cited by 16 publications

References 19 publications

Perianesthetic mortality in English Bulldogs: a retrospective analysis in 2010 – 2017

Perianesthetic mortality in English Bulldogs: a retrospective analysis in 2010 – 2017

The ASA Physical Status Classification: What Is the Evidence for Recommending Its Use in Veterinary Anesthesia?—A Systematic Review

Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: A retrospective study of 56 cases

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