Assessing major influences on decision-making and outcome for dogs presenting emergently with nontraumatic hemoabdomen

Jenna V. Menard Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY

Search for other papers by Jenna V. Menard in
Current site
Google Scholar
PubMed
Close
 BS
,
Skylar R. Sylvester Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY

Search for other papers by Skylar R. Sylvester in
Current site
Google Scholar
PubMed
Close
 DVM, DACVIM (Oncology)
, and
Daniel J. Lopez Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY

Search for other papers by Daniel J. Lopez in
Current site
Google Scholar
PubMed
Close
 DVM, DACVS

Abstract

OBJECTIVE

To evaluate factors contributing to owner decision-making, satisfaction, and perception of quality of life (QOL) with treatment of dogs with nontraumatic hemoabdomen (NTH).

ANIMALS

132 client-owned dogs.

PROCEDURES

An electronic survey was administered to owners of 436 dogs that presented emergently with NTH to a single institution between January 2015 and May 2022. Following survey response, retrospective data collection was performed.

RESULTS

Owners reported QOL as the most important factor influencing their decision-making (92%), followed by risk of cancer (57%) or time remaining with their pet (56%). QOL scores were significantly higher with surgery versus those with palliative care (P = .007). Median survival time (MST) was 213 days with surgery and 39 days with palliative care (P = .049). Survival benefit of surgery was lost when considering only dogs with malignant histopathology (MST, 81 days; P = .305). Owners were more likely to be satisfied when they chose surgery over either euthanasia or palliative care (P = .039). Thirty-four owners (26%) second-guessed or were unsure of their decision.

CLINICAL RELEVANCE

Surgery resulted in the longest MST with greater perceived QOL and owner satisfaction compared with both palliative care and euthanasia and should therefore be considered highly. The importance of malignancy and survival time on owners’ decisions, along with the negative impact of metastasis on survival, underscores the importance of timely preoperative staging. The rate of second-guessing highlights the need for standardization of NTH discussions including treatment options and potential outcomes in order to effectively and efficiently guide treatment of patients with this common presentation.

Abstract

OBJECTIVE

To evaluate factors contributing to owner decision-making, satisfaction, and perception of quality of life (QOL) with treatment of dogs with nontraumatic hemoabdomen (NTH).

ANIMALS

132 client-owned dogs.

PROCEDURES

An electronic survey was administered to owners of 436 dogs that presented emergently with NTH to a single institution between January 2015 and May 2022. Following survey response, retrospective data collection was performed.

RESULTS

Owners reported QOL as the most important factor influencing their decision-making (92%), followed by risk of cancer (57%) or time remaining with their pet (56%). QOL scores were significantly higher with surgery versus those with palliative care (P = .007). Median survival time (MST) was 213 days with surgery and 39 days with palliative care (P = .049). Survival benefit of surgery was lost when considering only dogs with malignant histopathology (MST, 81 days; P = .305). Owners were more likely to be satisfied when they chose surgery over either euthanasia or palliative care (P = .039). Thirty-four owners (26%) second-guessed or were unsure of their decision.

CLINICAL RELEVANCE

Surgery resulted in the longest MST with greater perceived QOL and owner satisfaction compared with both palliative care and euthanasia and should therefore be considered highly. The importance of malignancy and survival time on owners’ decisions, along with the negative impact of metastasis on survival, underscores the importance of timely preoperative staging. The rate of second-guessing highlights the need for standardization of NTH discussions including treatment options and potential outcomes in order to effectively and efficiently guide treatment of patients with this common presentation.

Supplementary Materials

    • Supplementary Appendix S1 (PDF 149 KB)
  • 1.

    Brockman DJ, Mongil CM, Aronson LR, Brown DC. A practical approach to hemoperitoneum in the dog and cat. Vet Clin North Am Small Anim Pract. 2000;30(3):657668. doi:10.1016/s0195-5616(00)50044-8

    • Search Google Scholar
    • Export Citation
  • 2.

    Pintar J, Breitschwerdt EB, Hardie EM, Spaulding KA. Acute nontraumatic hemoabdomen in the dog: a retrospective analysis of 39 cases (1987-2001). J Am Anim Hosp Assoc. 2003;39(6):518522. doi:10.5326/0390518

    • Search Google Scholar
    • Export Citation
  • 3.

    Aronsohn MG, Dubiel B, Roberts B, Powers BE. Prognosis for acute nontraumatic hemoperitoneum in the dog: a retrospective analysis of 60 cases (2003-2006). J Am Anim Hosp Assoc. 2009;45(2):7277. doi:10.5326/0450072

    • Search Google Scholar
    • Export Citation
  • 4.

    Fleming J, Giuffrida MA, Runge JJ, et al. Anatomic site and etiology of hemorrhage in small versus large dogs with spontaneous hemoperitoneum. Vet Surg. 2018;47(8):10311038. doi:10.1111/vsu.12963

    • Search Google Scholar
    • Export Citation
  • 5.

    Lux CN, Culp WTN, Mayhew PD, Tong K, Rebhun RB, Kass PH. Perioperative outcome in dogs with hemoperitoneum: 83 cases (2005-2010). J Am Vet Med Assoc. 2013;242(10):13851391. doi:10.2460/javma.242.10.1385

    • Search Google Scholar
    • Export Citation
  • 6.

    Millar SL, Curley TL, Monnet EL, Zersen KM. Premature death in dogs with nontraumatic hemoabdomen and splenectomy with benign histopathologic findings. J Am Vet Med Assoc. 2021;260(S1):S9S14. doi:10.2460/javma.21.01.0033

    • Search Google Scholar
    • Export Citation
  • 7.

    Schick AR, Hayes GM, Singh A, Mathews KG, Higginbotham ML, Sherwood JM. Development and validation of a hemangiosarcoma likelihood prediction model in dogs presenting with spontaneous hemoabdomen: the HeLP score. J Vet Emerg Crit Care (San Antonio). 2019;29(3):239245. doi:10.1111/vec.12838

    • Search Google Scholar
    • Export Citation
  • 8.

    Masyr AR, Rendahl AK, Winter AL, Borgatti A, Modiano JF. Retrospective evaluation of thrombocytopenia and tumor stage as prognostic indicators in dogs with splenic hemangiosarcoma. J Am Vet Med Assoc. 2021;258(6):630637. doi:10.2460/javma.258.6.630

    • Search Google Scholar
    • Export Citation
  • 9.

    Prymak C, McKee LJ, Goldschmidt MH, Glickman LT. Epidemiologic, clinical, pathologic, and prognostic characteristics of splenic hemangiosarcoma and splenic hematoma in dogs: 217 cases (1985). J Am Vet Med Assoc. 1988;193(6):706712.

    • Search Google Scholar
    • Export Citation
  • 10.

    Johnson KA, Powers BE, Withrow SJ, Sheetz MJ, Curtis CR, Wrigley RH. Splenomegaly in dogs. Predictors of neoplasia and survival after splenectomy. J Vet Intern Med. 1989;3(3):160166. doi:10.1111/j.1939-1676.1989.tb03092.x

    • Search Google Scholar
    • Export Citation
  • 11.

    Hammond TN, Pesillo-Crosby SA. Prevalence of hemangiosarcoma in anemic dogs with a splenic mass and hemoperitoneum requiring a transfusion: 71 cases (2003-2005). J Am Vet Med Assoc. 2008;232(4):553558. doi:10.2460/javma.232.4.553

    • Search Google Scholar
    • Export Citation
  • 12.

    Crawford AH, Tivers MS, Adamantos SE, Crawford AH. Owner assessment of dogs’ quality of life following treatment of neoplastic haemoperitoneum. Vet Rec. 2012;170(22):566. doi:10.1136/vr.100595

    • Search Google Scholar
    • Export Citation
  • 13.

    Molitoris A, Pfaff A, Cudney S, de Laforcade A. Early career clinicians euthanize more dogs with nontraumatic hemoabdomen but not gastric dilatation and volvulus than more experienced clinicians. J Am Vet Med Assoc. 2022;260(12):15141517. doi:10.2460/javma.22.05.0198

    • Search Google Scholar
    • Export Citation
  • 14.

    Dickerson VM, Coleman KD, Ogawa M, et al. Outcomes of dogs undergoing limb amputation, owner satisfaction with limb amputation procedures, and owner perceptions regarding postsurgical adaptation: 64 cases (2005-2012). J Am Vet Med Assoc. 2015;247(7):786792. doi:10.2460/javma.247.7.786

    • Search Google Scholar
    • Export Citation
  • 15.

    Tzannes S, Hammond MF, Murphy S, Sparkes A, Blackwood L. Owners ‘perception of their cats’ quality of life during COP chemotherapy for lymphoma. J Feline Med Surg. 2008;10(1):7381. doi:10.1016/j.jfms.2007.05.008

    • Search Google Scholar
    • Export Citation
  • 16.

    Owen LN. TNM Classification of Tumours in Domestic Animals. World Health Organization; 1980.

  • 17.

    Burgess KE, Price LL, King R, et al. Development and validation of a multivariable model and online decision-support calculator to aid in preoperative discrimination of benign from malignant splenic masses in dogs. J Am Vet Med Assoc. 2021;258(12):13621371. doi:10.2460/javma.258.12.1362

    • Search Google Scholar
    • Export Citation
  • 18.

    Spangler WL, Kass PH. Pathologic factors affecting postsplenectomy survival in dogs. J Vet Intern Med. 1997;11(3):166171. doi:10.1111/j.1939-1676.1997.tb00085.x

    • Search Google Scholar
    • Export Citation
  • 19.

    Schick AR, Grimes JA. Evaluation of the validity of the double two-thirds rule for diagnosing hemangiosarcoma in dogs with nontraumatic hemoperitoneum due to a ruptured splenic mass: a systematic review. J Am Vet Med Assoc. 2023;261(1):6973. doi:10.2460/javma.22.08.0389

    • Search Google Scholar
    • Export Citation
  • 20.

    Mullin C, Clifford CA. Miscellaneous tumors. In: Vail DM, Thamm DH, Liptak JM, eds. Withrow and MacEwen’s Small Animal Clinical Oncology. 6th ed. Elsevier; 2020:773810.

    • Search Google Scholar
    • Export Citation
  • 21.

    Wendelburg KM, Price LL, Burgess KE, Lyons JA, Lew FH, Berg J. Survival time of dogs with splenic hemangiosarcoma treated by splenectomy with or without adjuvant chemotherapy: 208 cases (2001-2012). J Am Vet Med Assoc. 2015;247(4):393403. doi:10.2460/javma.247.4.393

    • Search Google Scholar
    • Export Citation
  • 22.

    Wood CA, Moore AS, Gliatto JM, Ablin LA, Berg RJ, Rand WM. Prognosis for dogs with stage I or II splenic hemangiosarcoma treated by splenectomy alone: 32 cases (1991-1993). J Am Anim Hosp Assoc. 1998;34(5):417421. doi:10.5326/15473317-34-5-417

    • Search Google Scholar
    • Export Citation
  • 23.

    Fife WD, Samii VF, Drost WT, Mattoon JS, Hoshaw-Woodard S. Comparison between malignant and nonmalignant splenic masses in dogs using contrast-enhanced computed tomography. Vet Radiol Ultrasound. 2004;45(4):289297. doi:10.1111/j.1740-8261.2004.04054.x

    • Search Google Scholar
    • Export Citation
  • 24.

    Armbrust LJ, Biller DS, Bamford A, Chun R, Garrett LD, Sanderson MW. Comparison of three-view thoracic radiography and computed tomography for detection of pulmonary nodules in dogs with neoplasia. J Am Vet Med Assoc. 2012;240(9):10881094. doi:10.2460/javma.240.9.1088

    • Search Google Scholar
    • Export Citation
  • 25.

    Borgatti A, Winter AL, Stuebner K, et al. Evaluation of 18-F-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) as a staging and monitoring tool for dogs with stage-2 splenic hemangiosarcoma—a pilot study. PLoS One. 2017;12(2):e0172651. doi:10.1371/journal.pone.0172651

    • Search Google Scholar
    • Export Citation
  • 26.

    Siess S, Marziliano A, Sarma EA, Sikorski LE, Moyer A. Why psychology matters in veterinary medicine. Top Companion Anim Med. 2015;30(2):4347. doi:10.1053/j.tcam.2015.05.001

    • Search Google Scholar
    • Export Citation
  • 27.

    Netting FE, Wilson CC, New JC. The human-animal bond: implications for practice. Soc Work. 1987;32(1):6064. doi:10.1093/sw/32.1.60

Advertisement