Evaluation of short-term risk factors associated with dehiscence and death following full-thickness incisions of the large intestine in cats: 84 cases (1993–2015)

Cassie N. Lux From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996 (Lux, Roberts); Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602 (Grimes); Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061 (Benitez); Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616 (Culp, Ben-Aderet); and Martingale Consulting LLC, Media, PA 19063 (Brown). Dr. Roberts’ present address is the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108. Dr. Benitez's present address is Dogwood Veterinary Surgical Care PLLC, Cornelius, NC 28031.

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Sarah Roberts From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996 (Lux, Roberts); Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602 (Grimes); Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061 (Benitez); Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616 (Culp, Ben-Aderet); and Martingale Consulting LLC, Media, PA 19063 (Brown). Dr. Roberts’ present address is the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108. Dr. Benitez's present address is Dogwood Veterinary Surgical Care PLLC, Cornelius, NC 28031.

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Janet A. Grimes From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996 (Lux, Roberts); Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602 (Grimes); Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061 (Benitez); Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616 (Culp, Ben-Aderet); and Martingale Consulting LLC, Media, PA 19063 (Brown). Dr. Roberts’ present address is the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108. Dr. Benitez's present address is Dogwood Veterinary Surgical Care PLLC, Cornelius, NC 28031.

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Marian E. Benitez From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996 (Lux, Roberts); Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602 (Grimes); Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061 (Benitez); Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616 (Culp, Ben-Aderet); and Martingale Consulting LLC, Media, PA 19063 (Brown). Dr. Roberts’ present address is the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108. Dr. Benitez's present address is Dogwood Veterinary Surgical Care PLLC, Cornelius, NC 28031.

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William T. N. Culp From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996 (Lux, Roberts); Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602 (Grimes); Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061 (Benitez); Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616 (Culp, Ben-Aderet); and Martingale Consulting LLC, Media, PA 19063 (Brown). Dr. Roberts’ present address is the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108. Dr. Benitez's present address is Dogwood Veterinary Surgical Care PLLC, Cornelius, NC 28031.

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Daniel Ben-Aderet From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996 (Lux, Roberts); Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602 (Grimes); Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061 (Benitez); Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616 (Culp, Ben-Aderet); and Martingale Consulting LLC, Media, PA 19063 (Brown). Dr. Roberts’ present address is the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108. Dr. Benitez's present address is Dogwood Veterinary Surgical Care PLLC, Cornelius, NC 28031.

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Dorothy C. Brown From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996 (Lux, Roberts); Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602 (Grimes); Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061 (Benitez); Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616 (Culp, Ben-Aderet); and Martingale Consulting LLC, Media, PA 19063 (Brown). Dr. Roberts’ present address is the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108. Dr. Benitez's present address is Dogwood Veterinary Surgical Care PLLC, Cornelius, NC 28031.

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Abstract

OBJECTIVE

To evaluate short-term risk factors associated with dehiscence and death in cats undergoing full-thickness large intestinal incisions.

ANIMALS

84 client-owned cats that had undergone full-thickness large intestinal incisions and for which information regarding outcome through postoperative day 7 was available.

PROCEDURES

Medical records from 4 veterinary teaching hospitals were reviewed. For cats that met the inclusion criteria, signalment, history, laboratory test results, surgical and medical procedures, perioperative complications, and outcome were analyzed. A Fisher exact or Wilcoxon rank sum test was used to identify individual variables associated with dehiscence of intestinal incisions or patient nonsurvival to hospital discharge or both.

RESULTS

84 cats met the inclusion criteria. The overall dehiscence and survival to hospital discharge rates were 8.3% (7/84 cats) and 94% (79/84 cats), respectively. Factors associated with dehiscence and nonsurvival to hospital discharge included presence of band neutrophils, performance of partial colectomy with colonic resection and anastomosis, administration of blood products, postoperative cardiopulmonary arrest, and incisional inflammation or infection. Factors associated with nonsurvival to hospital discharge only included low serum globulin concentration, repair of colonic trauma or dehiscence, and postoperative colonic dehiscence. Factors associated with dehiscence only included hypoalbuminemia, renal dysfunction, administration of blood products or > 2 classes of antimicrobials, and intra-abdominal fecal contamination.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that intestinal dehiscence and mortality rates associated with large intestinal incisions in cats may be higher than previously proposed, although the risk of either outcome was still low. Factors suggestive of systemic illness were associated with colonic dehiscence or death, and focused prospective studies of risk factors are warranted. (J Am Vet Med Assoc 2021;259:162–171)

Abstract

OBJECTIVE

To evaluate short-term risk factors associated with dehiscence and death in cats undergoing full-thickness large intestinal incisions.

ANIMALS

84 client-owned cats that had undergone full-thickness large intestinal incisions and for which information regarding outcome through postoperative day 7 was available.

PROCEDURES

Medical records from 4 veterinary teaching hospitals were reviewed. For cats that met the inclusion criteria, signalment, history, laboratory test results, surgical and medical procedures, perioperative complications, and outcome were analyzed. A Fisher exact or Wilcoxon rank sum test was used to identify individual variables associated with dehiscence of intestinal incisions or patient nonsurvival to hospital discharge or both.

RESULTS

84 cats met the inclusion criteria. The overall dehiscence and survival to hospital discharge rates were 8.3% (7/84 cats) and 94% (79/84 cats), respectively. Factors associated with dehiscence and nonsurvival to hospital discharge included presence of band neutrophils, performance of partial colectomy with colonic resection and anastomosis, administration of blood products, postoperative cardiopulmonary arrest, and incisional inflammation or infection. Factors associated with nonsurvival to hospital discharge only included low serum globulin concentration, repair of colonic trauma or dehiscence, and postoperative colonic dehiscence. Factors associated with dehiscence only included hypoalbuminemia, renal dysfunction, administration of blood products or > 2 classes of antimicrobials, and intra-abdominal fecal contamination.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that intestinal dehiscence and mortality rates associated with large intestinal incisions in cats may be higher than previously proposed, although the risk of either outcome was still low. Factors suggestive of systemic illness were associated with colonic dehiscence or death, and focused prospective studies of risk factors are warranted. (J Am Vet Med Assoc 2021;259:162–171)

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