Perioperative mortality rate and risk factors for death in dogs undergoing surgery for treatment of thoracic trauma: 157 cases (1990–2014)

Cassie N. Lux Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.

Search for other papers by Cassie N. Lux in
Current site
Google Scholar
PubMed
Close
 DVM
,
William T. N. Culp Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

Search for other papers by William T. N. Culp in
Current site
Google Scholar
PubMed
Close
 VMD
,
Matthew S. Mellema Pet Emergency Center, 1100 Atlantic St, Roseville, CA 95678.

Search for other papers by Matthew S. Mellema in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
,
Desiree D. Rosselli VCA West Los Angeles Animal Hospital, 1900 S Sepulveda Blvd, Los Angeles, CA 90025.

Search for other papers by Desiree D. Rosselli in
Current site
Google Scholar
PubMed
Close
 DVM
,
Chad W. Schmiedt Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.

Search for other papers by Chad W. Schmiedt in
Current site
Google Scholar
PubMed
Close
 DVM
,
Ameet Singh Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

Search for other papers by Ameet Singh in
Current site
Google Scholar
PubMed
Close
 BSC, DVM, DVSc
,
April Haynes Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506.

Search for other papers by April Haynes in
Current site
Google Scholar
PubMed
Close
 DVM
,
Emily Schoenrock Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50014.

Search for other papers by Emily Schoenrock in
Current site
Google Scholar
PubMed
Close
 DVM
,
Laura E. Selmic Department of Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802.

Search for other papers by Laura E. Selmic in
Current site
Google Scholar
PubMed
Close
 BVetMed, MPH
,
Heidi Phillips Department of Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802.

Search for other papers by Heidi Phillips in
Current site
Google Scholar
PubMed
Close
 DVM
,
Milan Milovancev Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331.

Search for other papers by Milan Milovancev in
Current site
Google Scholar
PubMed
Close
 DVM
,
Philipp D. Mayhew Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

Search for other papers by Philipp D. Mayhew in
Current site
Google Scholar
PubMed
Close
 BVM&S
, and
Dorothy C. Brown Martingale Consulting LLC, Media, PA 19063.

Search for other papers by Dorothy C. Brown in
Current site
Google Scholar
PubMed
Close
 MSCE, DVM

Abstract

OBJECTIVE To determine perioperative mortality rate and identify risk factors associated with outcome in dogs with thoracic trauma that underwent surgical procedures and to evaluate the utility of the animal trauma triage (ATT) score in predicting outcome.

DESIGN Retrospective case series.

ANIMALS 157 client-owned dogs.

PROCEDURES Medical records databases of 7 veterinary teaching hospitals were reviewed. Dogs were included if trauma to the thorax was documented and the patient underwent a surgical procedure. History, signalment, results of physical examination and preoperative laboratory tests, surgical procedure, perioperative complications, duration of hospital stay, and details of follow-up were recorded. Descriptive statistics and ATT scores were calculated, and logistic regression analysis was performed.

RESULTS 123 of 157 (78%) patients underwent thoracic surgery, and 134 of 157 (85.4%) survived to discharge. Mean ± SD ATT score for nonsurvivors was 8 ± 2.4. In the multivariable model, female dogs and dogs that did not experience cardiac arrest as a postoperative complication had odds of survival 6 times and 102 times, respectively, those of male dogs and dogs that did experience cardiac arrest as a postoperative complication. Additionally, patients with a mean ATT score < 7 had odds of survival 5 times those of patients with an ATT score ≥ 7.

CONCLUSIONS AND CLINICAL RELEVANCE The overall perioperative mortality rate was low for patients with thoracic trauma undergoing surgery in this study. However, male dogs and dogs that experienced cardiac arrest had a lower likelihood of survival to discharge. The ATT score may be a useful adjunct to assist clinical decision-making in veterinary patients with thoracic trauma.

Abstract

OBJECTIVE To determine perioperative mortality rate and identify risk factors associated with outcome in dogs with thoracic trauma that underwent surgical procedures and to evaluate the utility of the animal trauma triage (ATT) score in predicting outcome.

DESIGN Retrospective case series.

ANIMALS 157 client-owned dogs.

PROCEDURES Medical records databases of 7 veterinary teaching hospitals were reviewed. Dogs were included if trauma to the thorax was documented and the patient underwent a surgical procedure. History, signalment, results of physical examination and preoperative laboratory tests, surgical procedure, perioperative complications, duration of hospital stay, and details of follow-up were recorded. Descriptive statistics and ATT scores were calculated, and logistic regression analysis was performed.

RESULTS 123 of 157 (78%) patients underwent thoracic surgery, and 134 of 157 (85.4%) survived to discharge. Mean ± SD ATT score for nonsurvivors was 8 ± 2.4. In the multivariable model, female dogs and dogs that did not experience cardiac arrest as a postoperative complication had odds of survival 6 times and 102 times, respectively, those of male dogs and dogs that did experience cardiac arrest as a postoperative complication. Additionally, patients with a mean ATT score < 7 had odds of survival 5 times those of patients with an ATT score ≥ 7.

CONCLUSIONS AND CLINICAL RELEVANCE The overall perioperative mortality rate was low for patients with thoracic trauma undergoing surgery in this study. However, male dogs and dogs that experienced cardiac arrest had a lower likelihood of survival to discharge. The ATT score may be a useful adjunct to assist clinical decision-making in veterinary patients with thoracic trauma.

Supplementary Materials

    • Supplementary Appendix s1 (PDF 80 kb)
    • Supplementary Table s1 (PDF 48 kb)

Contributor Notes

Address correspondence to Dr. Lux (clux@utk.edu).
  • 1. Wang SH, Wei TS, Chen CP. Prognostic analysis of patients with blunt chest trauma admitted to an intensive care unit. J Formos Med Assoc 2007;106:444451.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2. Simpson SA, Syring R, Otto CM. Severe blunt trauma in dogs: 235 cases (1997–2003). J Vet Emerg Crit Care (San Antonio) 2009;19:588602.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3. Spackman CJ, Caywood DD, Feeney DA, et al. Thoracic wall and pulmonary trauma in dogs sustaining fractures as a result of motor vehicle accidents. J Am Vet Med Assoc 1984;185:975977.

    • Search Google Scholar
    • Export Citation
  • 4. Shamir MH, Leisner S, Klement E, et al. Dog bite wounds in dogs and cats: a retrospective study of 196 cases. J Vet Med A Physiol Pathol Clin Med 2002;49:107112.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5. Scheepens ETF, Peeters ME, L'eplattenier HF, et al. Thoracic bite trauma in dogs: a comparison of clinical and radiological parameters with surgical results. J Small Anim Pract 2006;47:721726.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Shahar R, Shamir M, Johnston DE. A technique for management of bite wounds of the thoracic wall in small animals. Vet Surg 1997;26:4550.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. Hall KE, Holowaychuk MK, Sharp CR, et al. Multicenter prospective evaluation of dogs with trauma. J Am Vet Med Assoc 2014;244:300308.

  • 8. Shaw SR, Rozanski EA, Rush JE. Traumatic body wall herniation in 36 dogs and cats. J Am Anim Hosp Assoc 2003;39:3546.

  • 9. Risselada M, de Rooster H, Taeymans O, et al. Penetrating injuries in dogs and cats: a study of 16 cases. Vet Comp Orthop Traumatol 2008;21:434439.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Pawloski DR, Broaddus KD. Pneumothorax: a review. J Am Anim Hosp Assoc 2010;46:385397.

  • 11. Lisciandro GR. Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals. J Vet Emerg Crit Care (San Antonio) 2011;21:104122.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12. Cowell AK, Penwick RC. Dog bite wounds: a study of 93 cases. Compend Contin Educ Pract Vet 1989;11:313320.

  • 13. Davidson EB. Managing bite wounds in dogs and cats. Part II. Compend Contin Educ Pract Vet 1998;20:974991.

  • 14. Tattersall JA, Welsh E. Factors influencing the short-term outcome following thoracic surgery in 98 dogs. J Small Anim Pract 2006;47:715720.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Moores AL, Halfacree ZJ, Baines SJ, et al. Indications, outcomes and complications following lateral thoracotomy in dogs and cats. J Small Anim Pract 2007;48:695698.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Burton CA, White RN. Review of the technique and complications of median sternotomy in the dog and cat. J Small Anim Pract 1996;37:516522.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. Pape HC, Remmers D, Rice J, et al. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for clinical decision making. J Trauma 2000;49:496504.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18. Baker SP, O'Neill B, Haddon W, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187196.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Emircan S, Ozgüç H, Akköse Aydın S, et al. Factors affecting mortality in patients with thorax trauma. Ulus Travma Acil Cerrahi Derg 2011;17:329333.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20. Liman ST, Kuzucu A, Tastepe AI, et al. Chest injury due to blunt trauma. Eur J Cardiothorac Surg 2003;23:374378.

  • 21. Athanassiadi K, Theakos N, Kalantzi N, et al. Prognostic factors in flail-chest patients. Eur J Cardiothorac Surg 2010;38:466471.

  • 22. Perna V, Morera R. Prognostic factors in chest traumas: a prospective study of 500 patients. Cir Esp 2010;87:165170.

  • 23. Esme H, Solak O, Yurumez Y, et al. The prognostic importance of trauma scoring systems for blunt thoracic trauma. Thorac Cardiovasc Surg 2007;55:190195.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24. Rockar RA, Drobatz KS, Shofer FS. Development of a scoring system for the veterinary trauma patient. J Vet Emerg Crit Care (San Antonio) 1994;4:7783.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25. McKiernan BC, Adams WM, Huse DC. Thoracic bite wounds and associated internal injury in 11 dogs and 1 cat. J Am Vet Med Assoc 1984;184:959964.

    • Search Google Scholar
    • Export Citation
  • 26. Boller EM, Otto CM. Sepsis and shock. In: Silverstein DC, Hopper K, eds. Small animal critical care medicine. 2nd ed. St Louis: Saunders Elsevier, 2015;472473.

    • Search Google Scholar
    • Export Citation
  • 27. Hauptman JG, Walshaw R, Olivier NB. Evaluation of sensitivity and specificity of diagnostic criteria for sepsis in dogs. Vet Surg 1997;26:393397.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28. Osterbur K, Mann FA, Kuroki K, et al. Multiple organ dysfunction syndrome in humans and animals. J Vet Intern Med 2014;28:11411151.

  • 29. Keir I, Kellum JA. Acute kidney injury in severe sepsis: pathophysiology, diagnosis, and treatment recommendations. J Vet Emerg Crit Care (San Antonio) 2015;25:200209.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30. Ovbey DH, Wilson DV, Bednarski RM, et al. Prevalence and risk factors for canine post-anesthetic aspiration pneumonia (1999–2009): a multicenter study. Vet Anaesth Analg 2014;41:127136.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31. Streeter EM, Rozanski EA, Laforcade-Buress A, et al. Evaluation of vehicular trauma in dogs: 239 cases (January-December 2001). J Am Vet Med Assoc 2009;235:405408.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32. Stillion JR, Fletcher DJ. Admission base excess as a predictor of transfusion requirement and mortality in dogs with blunt trauma: 52 cases (2007–2009). J Vet Emerg Crit Care (San Antonio) 2012;22:588594.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33. Ateca LB, Drobatz KJ, King LG. Organ dysfunction and mortality risk factors in severe canine bite wound trauma. J Vet Emerg Crit Care (San Antonio) 2014;24:705714.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34. Wanek S, Mayberry JC. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin 2004;20:7181.

  • 35. Tart KM, Babski DM, Lee JA. Potential risks, prognostic indicators, and diagnostic and treatment modalities affecting survival in dogs with presumptive aspiration pneumonia: 125 cases (2005–2008). J Vet Emerg Crit Care (San Antonio) 2010;20:319329.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36. Nicholson M, Beal M, Shofer F, et al. Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: a retrospective study of 239 dogs and cats. Vet Surg 2002;31:577581.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37. Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010;39:460474.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38. Brainard BM, Alwood AJ, Kushner LI, et al. Postoperative pulmonary complications in dogs undergoing laparotomy: anesthetic and perioperative factors. J Vet Emerg Crit Care (San Antonio) 2006;16:184191.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39. Java MA, Drobatz KJ, Gilley RS, et al. Incidence of and risk factors for postoperative pneumonia in dogs anesthetized for diagnosis or treatment of intervertebral disk disease. J Am Vet Med Assoc 2009;235:281287.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40. Waldrop JE, Rozanski EA, Swanke ED, et al. Causes of cardiopulmonary arrest, resuscitation management, and functional outcome in dogs and cats surviving cardiopulmonary arrest. J Vet Emerg Crit Care (San Antonio) 2004;14:2229.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41. McIntyre RL, Hopper K, Epstein SE. Assessment of cardiopulmonary resuscitation in 121 dogs and 30 cats at a university teaching hospital (2009–2012). J Vet Emerg Crit Care (San Antonio) 2014;24:693704.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42. Hofmeister EH, Brainard BM, Egger CM, et al. Prognostic indicators for dogs and cats with cardiopulmonary arrest treated by cardiopulmonary cerebral resuscitation at a university teaching hospital. J Am Vet Med Assoc 2009;235:5057.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43. Snyder PS, Cooke KL, Murphy ST, et al. Electrocardiographic findings in dogs with motor vehicle-related trauma. J Am Anim Hosp Assoc 2001;37:5563.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44. Hayes G, Mathews K, Doig G, et al. The Acute Patient Physiologic and Laboratory Evaluation (APPLE) score: a severity of illness stratification system for hospitalized dogs. J Vet Intern Med 2010;24:10341047.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45. Meyer AA, Messick WJ, Young R, et al. Prospective comparison of clinical judgment and APACHE II score in predicting outcome in critically ill surgical patients. J Trauma 1992;32:747753.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46. Baker JL, Havas KA, Miller LA, et al. Gunshot wounds in military working dogs in Operation Enduring Freedom and Operation Iraqi Freedom: 29 cases (2003–2009). J Vet Emerg Crit Care (San Antonio) 2013;23:4752.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47. Palmer L, Martin L. Traumatic coagulopathy—part 1: pathophysiology and diagnosis. J Vet Emerg Crit Care (San Antonio) 2014;24:6374.

Advertisement