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)

Introduction

Gastrointestinal surgery is a commonly reported topic in the veterinary medical literature. Although there are known differences between the anatomic features and healing of the large and small intestines, several publications15 report outcomes of small and large intestine surgery combined. In addition, many of these reports combine information for dogs and cats, making it difficult to determine differences among species,2,46 or contain information pertaining only to surgical treatment of cats with megacolon.7,8

For small animal patients, it is theorized that dehiscence of large intestinal incisions is more likely to occur than dehiscence of small intestinal incisions owing to poor collateral blood supply, high bacterial load, and high intraluminal pressure during fecal bolus passage.9 Despite these concerns specific to the large intestine, results of previous studies3,7,10 that evaluated large intestinal incisions in cats do not support this comparatively higher risk of dehiscence. An overall gastrointestinal dehiscence rate of 0% in cats has been reported.2,3,7,10 In a study8 of cats undergoing colectomy for megacolon, 2 of 150 (1.3%) cats had dehiscence; of those 2 cats, only 1 developed generalized peritonitis and died. In a study4 evaluating gastrointestinal biopsy in dogs and cats, 24 of 172 cats underwent full-thickness incision of the large intestine; among all 172 cats, only 2 (1.2%) developed definite (as opposed to possible) dehiscence of the gastrointestinal biopsy site, and 1 of these 2 cats had undergone full-thickness incision of the colon.4 The only previously reported risk factor for intestinal dehiscence in cats is low preoperative serum albumin concentration, whereas risk factors for death of cats undergoing intestinal surgery include a diagnosis of neoplasia, intestinal dehiscence, and septic peritonitis.4,5

Overall, there is a paucity of information regarding large intestinal surgery in cats. The objectives of the study reported here were to determine the overall complication rate and evaluate short-term risk factors associated with incision site dehiscence and death (or euthanasia) prior to hospital discharge for cats undergoing full-thickness large intestinal incisions for various reasons. The authors hypothesized that the dehiscence rate following full-thickness large intestinal incisions in cats in the present study would be higher than previously reported rates, and factors associated with dehiscence would include preoperative hypoalbuminemia and preexisting septic peritonitis.

Materials and Methods

Case selection criteria

Medical records from 4 veterinary referral hospitals (University of California-Davis, University of Tennessee, University of Georgia, and Virginia-Maryland College of Veterinary Medicine) were reviewed from November 1993 to December 2015 to identify all cats that underwent laparotomy for surgical procedures requiring full-thickness incision into the large intestine. Cats were included if follow-up information (by direct examination of the patient or through owner or other veterinarian communication) was available for the period from surgery to ≥ 7 days after surgery for cats surviving to discharge. Cats were also included if they died or were euthanized within the first 7 postoperative days and information regarding nonsurvival was available for review. Cats were excluded if such follow-up information was not available or there was no information available for review of the procedures performed during surgery in the medical record.

Medical records review

Preoperative data including signalment, body weight, age, clinical signs, duration of clinical signs, time from hospital admission to surgery, results of laboratory blood analyses (ie, PCV, CBC, serum biochemical analysis, and assessments of whole blood lactate concentration, prothrombin time, and partial thromboplastin time), systolic arterial blood pressure measurements (in mm Hg), colonic cleansing procedures, and diagnostic imaging results were collected and recorded from each cat's medical record. Preoperative comorbidities were recorded and classified as cardiac disease, hepatopathy, nephropathy, hyperadrenocorticism, hypothyroidism, diabetes mellitus, enteropathy, and spinal neuropathy; the diagnosis of comorbidities was based on previous clinical diagnoses noted in the medical record, response to previous treatment, or histopathologic findings. Treatments administered during the operative period (defined as the interval from the beginning to the end of anesthesia for large intestine surgery) were documented, including blood product and antimicrobial administration. Antimicrobials were classified as preoperative treatments when their administration had been documented at the time of hospital admission or the medications had been administered prior to induction of anesthesia for surgical intervention, intraoperative treatments when the medications were administered only during the period of anesthesia (including the surgical procedure), and postoperative treatments when the medications had been administered following the cats’ recovery from anesthesia for longer than 24 hours after surgery.

Preoperative clinicopathologic variables (determined between hospital admission and prior to surgery) were defined as abnormal and used for statistical analysis as follows: thrombocytopenia (< 170 × 103 platelets/µL), neutrophilia (> 9 × 103 neutrophils/µL), leukocytosis (> 15 × 103 WBCs/µL), leukopenia (< 4.5 × 103 WBCs/µL), hyperproteinemia (total serum protein concentration, > 8.5 g/dL), hypoproteinemia (total serum protein concentration, < 6.0 g/dL), hypoalbuminemia (serum albumin concentration, < 3.0 g/dL), hyperglycemia (serum glucose concentration, > 180 mg/dL), hypoglycemia (serum glucose concentration, < 85 mg/dL), hyperlactatemia (serum lactate concentration, > 2.0 mmol/L), and high serum creatinine concentration (> 2.0 mg/dL). These cutoff values were chosen on the basis of the laboratory reference ranges at the authors’ institutions. For additional factors, values were classified as abnormal when they were outside the respective reference range. Anemia was classified on the basis of the PCV or Hct value (both when documented). The presence of band neutrophils identified by a CBC was documented as abnormal; toxic changes in neutrophils were recorded when this finding was noted in the medical record.

Intraoperative data collected included the overall surgical time (ie, the period from skin incision to completion of skin closure), total anesthesia time (interval from induction of anesthesia to extubation), and details of the surgical procedure. Data related to the surgical procedure included intraoperative complications, use of peritoneal drainage (closed suction or open abdominal drainage), evidence of preexisting peritonitis, classification of surgery type with recorded intestinal closure method (suture patterns and stapling devices used), and augmentations to the closure (eg, omental or serosal patching). Preexisting peritonitis was defined as the presence of features consistent with peritonitis (degenerated neutrophils with intracellular bacteria) detected during cytologic examination of peritoneal fluid samples, results of peritoneal fluid biochemical analyses supportive of peritonitis (fluid glucose concentration lower than serum glucose concentration and serum lactate concentration > 2.5 mmol/L), or identification of an intestinal wall defect during surgery. In addition, preexisting peritonitis could be defined by the presence of at least 2 of the following factors: ultrasonographic evidence of free abdominal fluid in addition to an intestinal wall defect or inflammation of the intestines and local tissues; gross evidence of petechiation, serosal inflammation, and intra-abdominal fecal contamination; and results of histologic or cytologic examinations or microbial culture of samples retrieved during surgery that confirmed peritonitis.

Surgeries were classified as colonic biopsy or colotomy, partial colectomy (< 75% of the colon resected) with colocolic anastomosis, partial colectomy with ileocolic resection and ileocolic anastomosis, partial colectomy with ileocolic resection and jejunocolic anastomosis, subtotal colectomy (> 75% to 99% of the colon resected) with preservation of the ileocolic junction and colorectal anastomosis, and total colectomy (100% of the colon resected) including the ileocolic junction with enterorectal anastomosis.

Postoperative complications were classified as gastrointestinal complications (vomiting, diarrhea, regurgitation, or anorexia), aspiration pneumonia (documented in the medical record with radiographic confirmation of the presence of disease, as evaluated by a board-certified radiologist), skin incision complications (seroma, dehiscence, or evidence of infection at the skin incision site), cardiac arrhythmias, and CPA. Postoperative large intestinal dehiscence was diagnosed on the basis of confirmation of the presence of septic abdominal effusion, detection of dehiscence at the time of a second procedure, or detection of dehiscence at the time of necropsy. When cats with confirmed or suspected large intestinal dehiscence underwent a second surgical procedure because of this complication, that information was recorded as well as any microbiological culture and antimicrobial susceptibility results for samples collected during that second procedure.

For purposes of this study, short-term survival time was defined as the interval from the time of surgery to hospital discharge. Additional survival information was recorded for the period from hospital discharge to 7 days after surgery. If death or euthanasia occurred at any time during the study period (ie, from hospital admission until 7-day follow-up) and information was available, it was documented as to whether the event was associated with the full-thickness large intestinal incisions or the underlying medical indication for large intestinal surgery; if neither factor was applicable, death or euthanasia was classified as unrelated. Medical records were searched for a medical examination report or owner or referring veterinarian communication to confirm each cat's survival to 7 days after surgery if they survived to discharge from the initial hospitalization. If this information could not be determined from the medical records, owners or veterinarians were contacted via telephone. The required 7-day follow-up time frame was only applicable to cats that survived to discharge from the hospital after the first surgical procedure; cats that underwent a second surgical procedure did not require 7 days of follow-up information to be included in the study. Any information that was available after the required 7 days was collected and documented for each case, if applicable, and presented only as descriptive data.

Statistical analysis

Descriptive statistics were calculated. Normally distributed continuous variables are presented as mean ± SD. Variables that were not normally distributed are presented as median and range. Categorical data are expressed as frequencies. There were too few cases of nonsurvival and intestinal dehiscence to perform multivariable logistic regression analysis; therefore, a Fisher exact (categorical data) or Wilcoxon rank sum (continuous data) test was used to identify individual variables extracted from the medical records, including the variables in the categories of history and clinical signs; findings of physical examination, diagnostic imaging, and clinicopathologic analyses, including predetermined high or low clinicopathologic values; pre-, intra-, and postoperative treatments administered; surgical factors such as indication for surgery, surgery type, intraoperative findings, and samples submitted for analysis; and development of postoperative complications that were associated with failure to survive to hospital discharge following the initial admission and intestinal dehiscence within a 7-day follow-up time frame. If a cat was hospitalized for > 7 days or developed dehiscence during the initial hospitalization, these time frames for the outcomes of failure to survive to hospital discharge and dehiscence within 7 days overlapped but were evaluated separately during statistical analysis. For cats that underwent a second surgery, only data from the first surgical procedure were included for statistical analysis. A value of P ≤ 0.05 was considered significant. All analyses were performed with commercially available software.a

Results

Records for 86 cats were submitted for evaluation of inclusion criteria, and 84 cats were determined to have met the inclusion criteria. The study population included 57 (67.9%) males (1 sexually intact and 56 neutered) and 27 (32.1%) females (1 sexually intact and 26 spayed). The cats’ mean ± SD age was 8.8 ± 4.5 years, and their mean weight was 4.5 ± 1.5 kg (9.9 ± 3.3 lb). Breeds represented included domestic shorthair (n = 50), domestic longhair (8), Siamese (6), domestic medium hair (3), Himalayan (3), Maine Coon (2), and 1 cat each of the Abyssinian, Persian, and Manx breeds; there were 9 mixed-breed cats. No signalment characteristics were identified as being associated with failure to survive to hospital discharge or intestinal dehiscence.

Preoperative findings

Among the 84 cats, the most commonly reported clinical sign prior to surgery was constipation in 54 (64.3%) cats, followed by weight loss (26 [31.0%] cats), vomiting (25 [29.8%] cats), anorexia (24 [28.6%] cats), diarrhea (21 [25.0%] cats), and hematochezia (11 [13.1%] cats). Forty of 84 (47.6%) cats had ≥ 2 clinical signs. Systolic noninvasive blood pressure readings were recorded for 9 of the 84 (10.7%) cats, and median systolic blood pressure was 126 mm Hg (range, 105 to 230 mm Hg). Anorexia was the only clinical sign significantly (P = 0.020) associated with intestinal dehiscence. The duration of clinical signs was > 6 months for 41 (48.8%) cats, > 4 weeks to 6 months for 26 (31.0%) cats, 1 to 4 weeks in 19 (22.6%) cats, and < 1 week in 16 (19.1%) cats. Because of their number of clinical signs, 19 of the 84 (22.6%) cats had ≥ 2 durations; as a result, some cats were classified into > 1 group. The duration of clinical signs from 1 to 4 weeks prior to surgery was significantly (P = 0.045) associated with intestinal dehiscence. There were no clinical signs associated with failure to survive to hospital discharge.

Preoperative CBC and serum biochemical analysis results for the 84 cats were summarized (Table 1). Anemia and thrombocytopenia were present in 28.4% (23/81) and 12.2% (5/41) of cats, respectively. Leukocytosis was present in 30.3% (23/76) of cats, and leukopenia was present in 2.6% (2/76) of cats. Neutrophilia was present in 48.0% (36/75) of cats, with a left shift and neutrophilic toxic change present in 29.5% (18/61) and 19.7% (12/61), respectively. Hyperproteinemia was detected in 6.7% (5/75) of cats, whereas hypoproteinemia and hypoalbuminemia were detected in 8.0% (6/75) and 36.4% (28/77) of cats, respectively. High blood lactate concentration was present in 33.3% (2/6) of cats. Hypoglycemia and hyperglycemia occurred at equal frequencies in this population, each affecting 7.2% (6/83) of cats. High serum creatinine concentration was evident in 12.2% (10/82) of cats. Urine specific gravity was measured for 7 of 10 cats with high serum creatinine concentration, and the median value for those cats was 1.026 (range, 1.010 to 1.054).

Table 1

Summary of clinicopathologic variables recorded prior to surgery of the large intestine in 84 cats.

Variable No. of cats Mean ± SD or median (range) Mean reference range values*
CBC
 PCV (%) 50 34.9 ± 8.2 30–50
 Hct (%) 78 34.3 ± 6.9 32–48
 WBC count (X 103 cells/µL) 76 12.1 (4.2–58.5) 3.5–15
 Lymphocyte count (X 103 cells/µL) 75 1.6 (0.28–13.1) 1.2–7.8
 Neutrophil count (X 103 cells/µL) 75 9.0 (2.1–31.8) 2.6–8.7
 Band neutrophil count (X 103 band cells/µL) 61 0 (0–2.5) 0–0.2
 Platelet count (X 103 platelets/µL) 41 350 (63.6–947) 170–480
Serum biochemical analysis
 Lactate (mmol/L) 6 1.4 (0.5–5.9) 0–2
 Total protein (g/dL) 75 7.3 ± 0.9 5.9–8.5
 Albumin (g/dL) 77 3.2 (1.3–3.9) 3.0–4.3
 Globulin (g/dL) 75 4.0 ± 0.77 2.4–4.2
 Serum glucose (mg/dL) 83 118 (70–362) 85–180
 BUN (mg/dL) 82 23 (10–88) 18–40
 Creatinine (mg/dL) 82 1.4 (0.5–4.8) 0.9–2.0
 Alanine aminotransferase (U/L) 78 42.5 (6–1,939) 29–109
 Total bilirubin (mg/dL) 76 0.1 (0–1.0) 0.1–0.7
 Potassium (mmol/L) 79 4.2 ± 0.6 2.9–4.8
 Sodium (mmol/L) 79 151.9 ± 4.3 146–157
 Urine specific gravity 26 1.031 (1.010–1.056) > 1.035
 Prothrombin time (s) 4 12.8 (10.5–30.3) 12–21
 Activated partial thromboplastin time (s) 5 15.3 (11–25.6) 12–20

Data were obtained from medical records of cats at 4 veterinary teaching hospitals.

The mean reference range values are the means of all 4 hospitals’ reference ranges.

The presence of band neutrophils was associated (P = 0.050) with failure to survive to discharge from the hospital; among nonsurviving cats, the median number of band neutrophils was 0 X 103 cells/µL (range, 0 to 2.5 × 103 cells/µL). Hypoglobulinemia was significantly (P = 0.001) associated with failure to survive to hospital discharge, and nonsurviving cats had a median serum globulin concentration of 2.9 g/dL (range, 2.7 to 3.1 g/dL; Table 2). Variables that were significantly associated with intestinal dehiscence were presence of band neutrophils (median number of band neutrophils in cats with dehiscence, 0.55 × 103 cells/µL; P = 0.004), presence of neutrophilic left shift (P = 0.005), high serum creatinine concentration (P = 0.035), and hypoalbuminemia (P = 0.040; Table 3).

Table 2

Factors significantly associated with failure to survive to discharge from the hospital for 84 cats that underwent large intestinal surgery at 4 veterinary teaching hospitals.

Factor No. of cats with factor Nonsurviving (n = 5) Surviving cats cats (n = 79) P value
Band neutrophil count* (X 103 band cells/µL) 20 0 (range, 0–2.5) 0 (range, 0–1.3) 0.05
Globulins* (g/dL) 75 2.9 (range, 2.7–3.1) 4.1 (range, 2.8–6.0) 0.001
Surgery type: partial colectomy (< 75% of colon resected) with colocolonic anastomosis 16 3 13 0.045
Surgical indication: repair of large intestine trauma or dehiscence 2 2 0 0.003
Postoperative complication: incisional inflammation or infection 2 2 0 0.003
Postoperative complication: CPA 3 3 0 < 0.001
Postoperative complication: large intestinal dehiscence 7 3 4 0.004
Administration of blood products 10 3 7 0.011

These cutoff values were chosen on the basis of the laboratory reference ranges at the authors’ institutions. Continuous variables were analyzed via Wilcoxon rank sum analysis. A value of P ≤ 0.05 was considered significant.

Value represents median value and range for cats that did or did not survive to discharge from the hospital.

Table 3

Factors significantly associated with large intestinal dehiscence for 84 cats that underwent large intestinal surgery at 4 veterinary teaching hospitals.

Factor No. of cats with factor No. of cats with dehiscence (n = 7) No. of cats without dehiscence (n = 77) P value
Clinical sign: anorexia 24 5 19 0.020
Band neutrophil count* (X 103 band cells/µL) 20 0.55 (range, 0–2.5) 0 (range, 0–1.3) 0.004
Presence of neutrophilic left shift 18 5 13 0.005
High serum creatinine concentration 10 3 7 0.035
Hypoalbuminemia 28 5 23 0.040
Comorbidity: nephropathy 9 3 6 0.025
Administration of > 2 classes of antimicrobials 11 5 6 < 0.001
Administration of blood products 10 3 7 0.035
Surgery type: partial colectomy (< 75% of colon resected) with colocolonic anastomosis 16 4 12 0.023
Intraoperative complication: intra-abdominal fecal contamination 4 2 2 0.034
Postoperative complication: incisional inflammation or infection 2 2 0 0.006
Postoperative complication: CPA 3 2 1 0.018

See Table 2 for key.

Comorbidities present among the 84 cats were classified as cardiac (15 [17.9%] cats), nephropathy (9 [10.7%] cats), previous pelvic trauma or spinal cord disease (4 [4.8%] cats), and enteropathy (3 [3.6%] cats); 1 (1.2%) cat had hypothyroidism and 1 (1.2%) cat had diabetes mellitus. Of the 9 cats classified as having nephropathy as a comorbidity on the basis of the medical record information, 8 had a high serum creatinine concentration prior to surgery. The presence of nephropathy as a comorbidity was significantly (P = 0.025) associated with intestinal dehiscence.

Preoperative diagnostic imaging was performed for 71 of the 84 (84.5%) cats. Tests performed included abdominal radiography (55 [65.5%] cats), abdominal ultrasonography (43 [51.2%] cats), thoracic radiography (41 [48.8%] cats), pelvic radiography (4 [4.8%] cats), barium contrast colography twice and pneumocolography once (3 [3.6%] cats), and echocardiography (1 [1.2%] cat). Some cats underwent > 1 diagnostic imaging procedure prior to surgery. Colonoscopy was performed prior to surgical intervention and during a separate anesthetic episode for 10 of the 84 (11.9%) cats. Colonic cleansing procedures were used in all 10 cats prior to colonoscopy, including administration of enemas (n = 8) or enteral osmotic fluid (2). Antimicrobials were administered to 16 (19.1%), 78 (92.9%), and 48 (57.1%) of the 84 cats during the preoperative, intraoperative, and postoperative periods, respectively. During hospitalization, 11 (13.1%) cats received > 2 classes of antimicrobials. Blood products were administered to 10 of the 84 (11.9%) cats, including infusions of packed RBCs (n = 7), fresh whole blood (5), and fresh frozen plasma (2). Two cats were transfused with > 1 blood product. Administration of blood products was significantly associated with intestinal dehiscence (P = 0.035) and failure to survive to discharge from the hospital (P = 0.011). Administration of > 2 classes of antimicrobials was associated with intestinal dehiscence (P < 0.001).

The mean ± SD time from hospital admission to the time of surgery, which was documented for all cats, was 1.79 ± 1.04 days. The indication for large intestinal surgery in the 84 cats included megacolon (45 [53.6%] cats), colonic mass (23 [27.4%] cats), biopsy (4 [4.8%] cats), colonic trauma or repair of previous dehiscence (2 [2.4%] cats), ileal or cecal mass (2 [2.4%] cats), intussusception (2 [2.4%] cats), stricture of the colon (2 [2.4%] cats), devitalized colon wall (1 [1.2%] cat), abscessed colonic duplication (1 [1.2%] cat), ulcerated colonic mucosa noted during colonoscopy (1 [1.2%] cat), and foreign body (1 [1.2%] cat). The operative reports detailing surgical findings and procedures for 79 of the 84 (94.0%) cats were available for review, and notes within the medical records provided the information required for study purposes for the other 5 cats. The intestinal procedures performed were subtotal colectomy with preservation of the ileocolic junction and colorectal anastomosis (33 [39.3%] cats), total colectomy including the ileocolic junction and enterorectal anastomosis (16 [19.0%] cats), partial colectomy with colocolic anastomosis (16 [19.0%] cats), colonic biopsy or colotomy (8 [9.5%] cats), partial colectomy with ileocolic junction resection and jejunocolic anastomosis (6 [7.1%] cats), and partial colectomy with ileocolic junction resection and ileocolic anastomosis (5 [6.0%] cats). The recorded purposes for colonic biopsy in 4 cats included determination of the cause of chronic vomiting (n = 1), diarrhea (1), recurrent colitis with rectal prolapse (1), or hematochezia (1). Peritonitis was documented for 1 cat on the basis of the evidence of gross contamination of the abdomen during the initial surgery, but no cat underwent postoperative abdominal drainage by any means. The most common intestinal closure suture pattern was an interrupted pattern (66/84 [78.6%] cats), whereas the remaining intestinal closures were performed with a simple continuous suture pattern (15/84 [17.9%] cats) or use of a surgical stapling device (3/84 [3.6%] cats). The mean ± SD anesthesia and surgical times for all cats were 172.8 ± 49.8 minutes and 119.3 ± 37.6 minutes, respectively. All 84 cats survived the first surgical event, including the time from induction of anesthesia to the end of the surgical procedure.

Factors associated with failure to survive to discharge from the hospital were the indications for surgery of repair of colonic trauma or dehiscence (P = 0.003) and partial colectomy with colocolic anastomosis (P = 0.045). Also, the presence of megacolon as the indication for surgery was significantly (P = 0.024) negatively associated with failure to survive to hospital discharge; all cats with this surgical indication survived to discharge from the hospital. The surgical procedure of partial colectomy with colocolic anastomosis was also associated with intestinal dehiscence (P = 0.023).

In the medical records for the 84 cats, documented intraoperative complications included hypotension (19 [22.6%] cats), iatrogenic intra-abdominal fecal contamination (4 [4.8%] cats), and hemorrhage (2 [2.4%] cats). Hypothermia was the only documented complication occurring in the operative period (9 [10.7%] cats). The most common postoperative complications were those associated with the gastrointestinal tract (ie, vomiting, diarrhea, nausea, and inappetence), which developed in 46 (54.8%) cats. Additionally, 2 (2.4%) cats developed inflammation or infection associated with the skin incision, and 3 (3.6%) cats had CPA. Of the 3 cats that had CPA, 2 had a poor anesthetic recovery from which they progressed to CPA, and 1 of those 2 cats had spontaneous return of circulation and was ventilated until the diagnosis of intestinal dehiscence. A single cat developed chylothorax and intestinal dehiscence after surgery, which were followed by CPA. Factors associated with failure to survive to discharge from the hospital included postoperative complications of skin incision inflammation or infection (P = 0.003) and CPA (P < 0.001). Factors associated with intestinal dehiscence included intraoperative iatrogenic intra-abdominal fecal contamination (P = 0.034), postoperative inflammation or infection of the skin incision (P = 0.006), and the complication of CPA (P = 0.018).

Because of inflammation or adhesions within the abdominal cavity, swab samples were obtained from 5 of 84 (6.0%) cats during the first surgery and were submitted for microbial culture. Three of 5 samples yielded bacteria (Enterococcus spp [n = 2 cats], Escherichia coli [2 cats], and an unidentified anaerobic rod organism [1 cat]). Tissue samples were submitted for histologic examination from 69 of 84 (82%) cats. The most common diagnosis of malignancy was carcinoma for 19 of 69 (27.5%) cats, specifically colonic adenocarcinoma (n = 17 cats), colonic adenosquamous carcinoma (1 cat), and cecal adenocarcinoma (1 cat). A histologic diagnosis of lymphoma was made for 3 (4.3%) cats, and 3 (4.3%) cats were diagnosed with colonic sarcoma. For the 25 cats with malignant neoplasia, 11 (44%) had evidence of metastatic disease in the lymph nodes (9 cats), the liver (1 cat), or both the lymph nodes and liver (1 cat). Lymphatic or vascular invasion of the neoplasm was documented in the medical records of 4 of the 25 cats, whereas extension of the tumor through the serosa was noted for 3 of the 25 cats. Two of the 25 cats had carcinomatosis. Margin evaluation of excised tissue was either not performed or not documented for 10 of the 25 cats with a malignant neoplasm. In the 15 cases that had documentation of margin evaluation, 7 had a clean margin, and 8 had tumor cells within 4 mm or at the cut edges of submitted tissues. The surgical procedures performed for the 25 cats with diagnoses of malignancy included partial colectomy with colocolic anastomosis (11 [44%] cats), partial colectomy with ileocolic junction resection and ileocolic anastomosis (4 [16.0%] cats), partial colectomy with ileocolic junction resection and jejunocolic anastomosis (3 [12.0%] cats), total colectomy including the ileocolic junction and enterorectal anastomosis (3 [12.0%] cats), subtotal colectomy with preservation of the ileocolic junction and colorectal anastomosis (2 [8.0%] cats), and colonic biopsy only (2 [8.0%] cats). Histologic examination of the tissue samples from 69 cats revealed inflammatory lesions in 7 (10.1%), including neutrophilic ulcerative colitis (2 cats), lymphoplasmacytic colitis (3 cats), eosinophilic sclerosing fibroplasia (1 cat), and ulcerative typhlitis with stenosis (1 cat). There was no association between histologic diagnosis and either survival to discharge from the hospital or intestinal dehiscence.

Dehiscence of the intestinal incision occurred in 7 of 84 (8.3%) cats; the mean ± SD time to diagnosis of dehiscence was 4 ± 2.34 days after surgery. Among the cats with intestinal dehiscence, 2 developed intestinal dehiscence following discharge from the hospital. One of those 2 cats was euthanized following development of abdominal sepsis 8 days following hospital discharge, although it was unclear whether dehiscence had occurred earlier, and the other died (dehiscence detected at necropsy) 15 days following discharge from the hospital. A second surgery was performed in 2 of the 7 cats with large intestinal dehiscence following the initial surgery during the study period, including a cat with dehiscence of a colorectal incision that was initially repaired during the first surgery because of a perineal fistula within a perineal hernia. Dehiscence of the intestinal incisions in the 7 cats was identified on the basis of ultrasonographic and cytologic findings consistent with septic peritonitis (n = 4), direct visualization during a second surgical procedure (2), and findings during necropsy (1).

Seventy-nine of 84 (94%) cats survived to discharge from the hospital, and the median time to hospital discharge for all patients following surgery was 3 days (range, 1 to 10 days). The indications for surgery for the 5 cats that failed to survive to hospital discharge were repair of large intestinal trauma or dehiscence (n = 2), colonic mass (2), and devitalization and stricture of the large intestine (1). Of the 5 cats that did not survive to hospital discharge, 4 were euthanized. The reasons for euthanasia included poor recovery from anesthesia and subsequent development of an unresponsive state (n = 2 cats) and diagnosis of dehiscence (2 cats); 1 cat died after surgery as a result of septic peritonitis and large intestinal dehiscence. Only 2 of 7 cats with dehiscence survived long term, including the 1 cat that had undergone repair of colorectal dehiscence following diagnosis of perineal fistula. The other cat, whose owner declined a second surgery, was alive 1 month later with only medical management of abdominal sepsis. The occurrence of intestinal dehiscence was significantly (P = 0.004) associated with failure to survive to discharge from the hospital.

Discussion

To the authors’ knowledge, this multi-institutional study is one of the largest analyses of risk factors associated with full-thickness large intestinal incisions in cats. All 84 cats in the present retrospective study survived the surgical procedure, and 94% of cats survived to discharge from the hospital. The overall dehiscence rate at a minimum of 7 days after surgery was 8.3%. Numerous factors were associated with both failure to survive to hospital discharge and intestinal dehiscence, including the presence of band neutrophils, administration of blood products, performance of partial colectomy with colonic resection and anastomosis, postoperative skin incision inflammation or infection, and postoperative CPA. It is notable that all cats requiring surgery for treatment of megacolon survived and that this indication for surgery was significantly negatively associated with failure to survive to hospital discharge.

The pre–hospital-discharge mortality rate was low in this population of cats. Although direct comparison of the present study's findings with published information is challenging, the mortality rate of the present study was similar to the rates (ie, 6.9% to 16.7%) determined in some studies35 of all types of intestinal surgery in cats. However, the mortality rate in the present study was higher than previously reported rates for cats undergoing large intestinal surgery (ie, 0% to 1.3%).7,8,10 On review of data for cats with megacolon, it was concluded that cats that underwent surgical intervention uncommonly had complications that were life-threatening or occurred secondary to surgical intervention,11 and the results of the present study confirmed this finding. Results of the present study indicated that cats treated for megacolon may have a better overall short-term prognosis, compared with cats undergoing full-thickness large intestinal incisions for other indications.

The severity of systemic illness or debilitation in the cats of the present study was likely related to the extent of several major factors that significantly impacted survival rate, namely higher numbers of band neutrophils, lower serum globulin concentration, and administration of blood products. The most common causes of hypoglobulinemia include hemorrhage attributable to trauma, gastrointestinal ulceration, or neoplasia; hepatic insufficiency; and protein-losing enteropathy.12 It was possible for cats of the present study to have developed enteropathy-associated hypoglobulinemia, but that could not be concluded from the available medical record information.

The authors speculated that hemorrhage may have occurred in the nonsurviving cats because administration of blood products was also associated with failure to survive to discharge from the hospital. In a retrospective study13 that evaluated outcomes for cats with septic peritonitis that underwent surgical treatment, none of the cats that received a blood transfusion survived to hospital discharge, although these data were not statistically analyzed to determine an association. Additionally, in another study,14 analysis of all cats receiving blood product transfusions in a single hospital revealed that the most common causative factors for requirement of a blood transfusion included blood loss from surgery, gastrointestinal bleeding, and neoplasia; moreover, cats that received blood transfusions were significantly less likely to survive to hospital discharge, compared with hospitalized cats that did not receive blood transfusions.14

The presence of band neutrophils or a neutrophilic left shift is common in cats with sepsis or a source of sepsis, with a left shift detected in 19 of 26 (73%) cats with naturally occurring sepsis in 1 study,15 and either finding is often considered a prognostic indicator for death.16,17 In the study of the present report, the presence of band neutrophils was significantly associated with large intestinal dehiscence and failure to survive to hospital discharge, and a neutrophilic left shift was associated with large intestinal dehiscence. Although only a single cat in the present study was deemed to have preexisting septic peritonitis at the time of the initial surgery, it was possible that cases of concurrent systemic sepsis or septic peritonitis were missed or poorly documented in the medical records. There are limited data available regarding systemic sepsis in cats, but in general, systemic sepsis is diagnosed when SIRS is confirmed in patients with a definitive source of infection.15,16 A limitation of most retrospective studies includes incomplete medical records, and in the study of the present report, accurate diagnosis of SIRS in the 84 cats was not possible; therefore, the cats could not be classified as having systemic sepsis. Despite the inability to confirm SIRS and systemic sepsis in the cats of the present study, it was likely that record notation of the presence of band neutrophils or a neutrophilic left shift before surgery at least indicated that those cats were systemically ill.

Postoperative complications associated with failure to survive to hospital discharge included large intestinal dehiscence and CPA. Of 3 cats that had CPA, none survived to hospital discharge and 2 also had intestinal dehiscence. In a study18 of 121 dogs and 30 cats that had CPA and underwent CPR, the hospital discharge rate was 5%. In 2 previous reports,18,19 CPA as a result of infection, inflammation, or severe systemic disease occurred in 9% to 17% of dogs and cats. In the present study, it was postulated that the presence of preoperative marked systemic disease or development of postoperative intestinal dehiscence that predisposed a cat to severe systemic illness resulted in CPA in 3.6% of this population.

The development of postoperative large intestinal dehiscence in 7 of 84 (8.3%) cats in this study was a higher dehiscence rate than those determined in previous studies24,7,8,10 of intestinal dehiscence in cats (ie, 0% to 1.3%). It has been reported that hypoalbuminemia in cats is a risk factor for intestinal dehiscence,4 and it was similarly identified as a risk factor for large intestinal dehiscence in the present study. Hypoalbuminemia can develop secondary to malnutrition, hepatic dysfunction, increased capillary permeability, or decreased albumin production because of increased acute-phase protein production.20,21 It has been documented as a common finding in cats with sepsis; hypoalbuminemia was identified in 56% to 100% of cats in which serum albumin concentration was measured in previous studies.13,16,20,21 However, hypoalbuminemia has not been reported to be significantly associated with survival to discharge or overall mortality rate.13,16,20 Because documentation of systemic sepsis was not available for the cats of the present study, it could not be confidently associated with hypoalbuminemia from the study data. Anorexia has also been recorded as a common clinical sign in cats with sepsis,13,15 but it is considered a vague and nonspecific finding.3,10 Anorexia was recorded for 24 of the 84 (28.6%) cats in the present study and was associated with large intestinal dehiscence. The association between anorexia and large intestinal dehiscence could be related to the fact that anorectic cats may have already developed more marked or chronic systemic disease or that poor enteral nutrition caused a predisposition to large intestinal dehiscence.

Another serum biochemical abnormality associated with large intestinal dehiscence was high serum creatinine concentration. High serum creatinine concentration at the time of presentation was recorded for 10 of 82 (12.2%) cats in which it was measured. Furthermore, nephropathy as a comorbidity was associated with large intestinal dehiscence. Nephropathy was recorded for 9 of the 84 (10.7%) cats in the present study. Although the specific cause of nephropathy was not defined in this study, the noted nephropathy was likely related to chronic kidney disease because chronic kidney disease is a common condition in older cats.22 Chronic kidney disease is an important cause of morbidity and death in cats and may relate to malnutrition and poor body condition.23 Among the cats of the present study, high serum creatinine concentration could have been related to chronic kidney disease or secondary to other systemic causes, such as dehydration. Acute kidney injury is a strong predictor of death for cats with sepsis,24 and circulating urea concentration has been shown to have good discriminant capacity for association with death as determined by the area under the receiver operating characteristic curve in an investigation to establish a feline acute patient physiologic and laboratory evaluation score.25 It is likely that the 8 cats with nephropathy as a comorbidity and high serum creatinine concentration represented a subset of more systemically ill cats in the present study, a fact that may have contributed to the association of nephropathy with large intestinal dehiscence.

Antimicrobials were given in the operative period to 78 of the 84 (93%) cats in the present study, likely because the procedures were considered clean-contaminated.26 The time frame of administration of antimicrobials and intestinal dehiscence were not related. However, only 11 (13.1%) cats received > 2 classes of antimicrobials, and this factor was associated with large intestinal dehiscence. A previously published study27 revealed that in dogs with septic peritonitis, recent abdominal surgery was associated with subsequent inappropriate empirical antimicrobial treatment. In humans, administration of appropriate antimicrobials within the first hour after onset of sepsis-related hypotension improves outcome and survival rate.28 The use of multiple classes of antimicrobials in the present study could reflect attempts to broaden the spectrum of coverage in cats that appeared more systemically ill or had signs of sepsis, provide appropriate treatment following receipt of positive culture results, or provide additional coverage following surgery when contamination occurred. Interestingly, intraoperative contamination during surgery (as noted in the records) was also associated with intestinal dehiscence in the present study; however, whether additional antimicrobials were administered as a direct result of intraoperative contamination cannot be determined in a retrospective analysis.

Partial colectomy with colocolic anastomosis was associated with both failure to survive to discharge from the hospital and large intestinal dehiscence. This combined surgical procedure was performed in 16 cats and was predominantly used to treat colonic malignancies (11/16 [68.8%]). It could be considered that of the cats in the present study, cats with colonic masses were more systemically affected given that colonic masses can often cause weight loss, anorexia, and diarrhea of considerable duration.10 Interestingly, in a study10 of cats with colonic adenocarcinoma treated via subtotal colectomy, there were no reported instances of intestinal dehiscence or death. Another consideration includes whether the surgical procedure was sufficient to control the local disease in the large intestine. Many cats with malignant neoplasms (including 4/11 cats that underwent partial colectomy and colocolic anastomosis) did not have a postoperative margin evaluation of the excised tissues performed or recorded. This group of cats with no tissue margin evaluation included 3 cats with extension or invasion of the tumor into the serosa of the large intestine and 1 cat with diffuse carcinomatosis of the abdomen. The available margin evaluation data for the remaining 7 cats undergoing this procedure included 4 cats with tumor cells within 4 mm or at the cut edge of the tissues submitted and 3 cats with clean margins. Perhaps treatment of the study cats with partial colectomy and colocolic anastomosis did not provide adequate surgical margins to remove all colonic disease, predisposing those cats to large intestinal dehiscence and failure to survive to hospital discharge.

Limitations of the present study included those inherent to retrospective analysis, such as incomplete medical records information, inconsistent reporting of results of pre- and postoperative laboratory analyses and diagnostic testing, and differences in pre- and postoperative care and patient follow-up. For these reasons, it was difficult to evaluate the cats for the presence of SIRS and systemic sepsis, which could have revealed other factors for analysis. To the authors’ knowledge, this was one of the largest studies in which various indications for large intestinal surgery in cats were assessed, yet the number of cats that failed to survive to hospital discharge and had intestinal dehiscence was small. As a result, logistic regression analysis of the data could not be performed; therefore, ORs were not determined for factors associated with failure to survive to hospital discharge or large intestinal dehiscence. For 2 cats, intestinal dehiscence was diagnosed after the required 7-day postoperative follow-up period, so it was possible that the required 7-day follow-up time frame did not capture all cases of dehiscence. However, the mean ± SD time for dehiscence in this population of cats was 4 ± 2.34 days. The final consideration for the present study included the causative factors for the mortality rate in the study cats. Euthanasia of 4 of 5 nonsurviving cats was performed, largely driven by owner decisions made on the basis of prognostic information, financial limitations, and personal concerns. Although owner decision is a factor in all clinical veterinary studies, it must be noted that mortality rates are influenced by factors other than complications or disease progression.

The results of the present study confirmed the hypothesis that the rate of large intestinal dehiscence in cats is low (8.3%), but possibly higher than those previously reported, and confirmed that hypoalbuminemia was associated with intestinal dehiscence. The results of the study did not support that preexisting septic peritonitis was associated with large intestinal dehiscence; although this finding could be related to a type II error, this was one of the largest populations of cats evaluated following large intestinal surgery. However, it is important to note that the indications for surgery of colonic trauma or dehiscence and postoperative intestinal dehiscence were associated with failure to survive to hospital discharge. There were numerous factors identified as possible indicators of severe systemic disease that were significantly associated with large intestinal dehiscence and failure to survive to hospital discharge. In addition, some previously unidentified factors were associated with failure to survive to hospital discharge (hypoglobulinemia) and large intestinal dehiscence (anorexia, evidence of renal dysfunction, and administration of > 2 classes of antimicrobials), and these factors may also be indicators of systemic disease. The information provided by the study of the present report may help guide veterinarians to determine prognoses for cats that require full-thickness incisions of the large intestine, and might suggest systemic factors to consider when evaluating risks for death and postoperative large intestinal dehiscence in cats undergoing such treatment.

Abbreviations

CPA

Cardiopulmonary arrest

SIRS

Systemic inflammatory response syndrome

Acknowledgments

The completion of this study was supported by the University of Tennessee Center of Excellence Summer Research Experience.

The authors declare that there were no conflicts of interest.

Footnotes

a.

Stata, version 13.0, StataCorp, College Station, Tex.

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Contributor Notes

Address correspondence to Dr. Lux (clux@utk.edu).
  • 1.

    Ellison GW. Complications of gastrointestinal surgery in companion animals. Vet Clin North Am Small Anim Pract 2011;41:915934.

  • 2.

    Ralphs SC, Jessen CR, Lipowitz AJ. Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991–2000). J Am Vet Med Assoc 2003;223:7377.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Smith AL, Wilson AP, Hardie RJ, et al.. Perioperative complications after full-thickness gastrointestinal surgery in cats with alimentary lymphoma. Vet Surg 2011;40:849852.

    • Search Google Scholar
    • Export Citation
  • 4.

    Swinbourne F, Jeffery N, Tivers MS, et al.. The incidence of surgical site dehiscence following full-thickness gastrointestinal biopsy in dogs and cats and associated risk factors. J Small Anim Pract 2017;58:495503.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Wylie KB, Hosgood GH. Mortality and morbidity of small and large intestinal surgery in dogs and cats: 74 cases (1980–1992). J Am Anim Hosp Assoc 1994;30:469474.

    • Search Google Scholar
    • Export Citation
  • 6.

    Yoon HY, Mann FA. Bilateral pubic and ischial osteotomy for surgical management of caudal colonic and rectal masses in six dogs and a cat. J Am Vet Med Assoc 2008;232:10161020.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Rosin E, Walshaw R, Mehlhaff C, et al.. Subtotal colectomy for treatment of chronic constipation associated with idiopathic megacolon in cats: 38 cases (1979–1985). J Am Vet Med Assoc 1988;193:850853.

    • Search Google Scholar
    • Export Citation
  • 8.

    Rosin E. Megacolon in cats: the role of colectomy. Vet Clin North Am Small Anim Pract 1993;23:587594.

  • 9.

    Radlinsky MG. Surgery of the digestive system. In: Fossum TW, ed. Small animal surgery. 4th ed. St Louis: Mosby Elsevier, 2012;386583.

    • Search Google Scholar
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