Variables Associated with Outcome in Dogs Undergoing Extrahepatic Biliary Surgery: 60 Cases (1988–2002)

Abstract

Septic bile peritonitis, preoperative elevated creatinine concentration, and immediate postoperative hypotension in dogs undergoing extrahepatic biliary tract surgery are associated with a poor clinical outcome. Adequate supportive care and monitoring in the perioperative period is critical to improve survival of dogs with extrahepatic biliary disease.

Clinical Findings and Prognostic Factors for Dogs Undergoing Cholecystectomy for Gall Bladder Mucocele

“…Previous studies have shown PTT times, serum concentrations of albumin, globulin, and bilirubin, percentage of band neutrophils, and total lymphocyte counts to also be risk factors for death 10,12,13 In the same studies, reported preoperative risk factors for death in dogs undergoing biliary surgery include age, preanesthetic heart rate, blood urea nitrogen, serum creatinine, GGT, phosphorus, and bilirubin values. 10,12 The risk of death in our dogs increased 0.3 times (30%) for each increment in lactate concentration elevation in the postoperative period. Serum lactate concentrations have been previously investigated in dogs as a significant negative prognostic indicator in disease processes such as gastric dilatation and volvulus, and babesiosis.…”

“…Our finding, however, supports a previous report that found postoperative hypotension to be a significant risk factor for mortality in cases undergoing extrahepatic biliary surgeries. 12 It therefore, warrants careful perioperative monitoring of cases undergoing cholecystectomy, to allow early detection and aggressive management.…”

“…Higher rates of positive culture results have been reported when other surgically treated biliary diseases have been investigated with reports as high as 35-50%. 12,22 Gall bladder rupture can result from physical distension of the gall bladder and subsequent ischemic necrosis of the gall bladder wall that can lead to leakage into the peritoneal cavity resulting in septic or aseptic bile peritonitis, depending on the gall bladder content. Mortality rates for dogs with septic bile-induced peritonitis and dogs with aseptic peritonitis have been reported to be 55-73% and 0-13%, respectively, based on different studies.…”

“…The proposed underlying causes of postoperative hypotension include prolonged anesthesia, inadequate fluid administration, systemic inflammatory response syndrome (SIRS), and/or sepsis. 12 The postoperatively hypotensive dogs in our study were managed using crystalloid fluid therapy with or without colloid products, blood products such as fresh frozen plasma, packed red blood cells, and whole blood transfusions, as well as inotropes (eg dopamine), and vasopressors (eg norepinephrine) infusions as adjuvant support to control hypotension as needed. Both dogs that experienced clinical postoperative hypotension were euthanatized in the hospital because of poor response to treatment.…”

“…7,9 Although the reported perioperative mortality ranges from 21.7% to 40%, 1,2,8 the prognosis for a dog with GM undergoing cholecystectomy is generally favorable if the dog survives the immediate postoperative period. 1,2,[10][11][12] Long-term outcome for dogs surviving surgery and the immediate postoperative period is good with 1 study reporting both 1-and 2-year survival rates of 22 of 34 (66%). 10 Our objectives were to report the clinical and intraoperative findings in dogs with GM undergoing cholecystectomy and to determine prognostic factors.…”