Pyometra is a common disease of sexually intact female dogs1,2 and has been studied extensively as a model for sepsis and systemic inflammation.3–7 Ovariohysterectomy (OHE) is well established as the recommended treatment for all cases of pyometra except in the most valuable breeding dogs.1,2 The prognosis for pyometra treated by OHE is good, with mortality rates reported to be low, with deaths associated with sepsis or acute kidney injury.1,8 Complications such as peritonitis and ruptured uterus can occur1,8; however, with prompt surgery, the prognosis is still thought to be good even when patients are systemically ill.1,3,4,6
Despite the excellent prognosis for this disease, many dog owners are unable to afford the cost of emergency OHE for pyometra, which may lead to euthanasia or death from untreated infection. It is well recognized that, for a variety of reasons, low-income pet owners are less likely to have dogs that are spayed.9 Pyometra is therefore common among pets with owners who struggle to access veterinary care as a result of finances or other barriers.10,11 Reported surgical costs for urgent or emergent treatment of pyometra in emergency and critical care practices, including the costs for hospitalization and surgical treatment, can exceed $4,000.12 In daytime primary care practices, the costs can often be only slightly less, although it varies somewhat with geographic location.12 Pyometra may also be treated in an outpatient setting, such as may occur in a high-quality, high-volume spay–neuter (HQHVSN) clinic, although limited information exists regarding the outcome of these cases, and, by the nature of HQHVSN clinics, overnight care is not provided.12
Although OHE for pyometra can be performed in general practice, it is less common in many locations, likely because of the difficulty of adding an urgent surgical procedure in a busy hospital, because of a migration away from nonroutine soft tissue surgeries by practitioners, and because of the perception that pyometra patients need specialized care or that surgery for pyometra must be performed as soon as possible if the patient is to survive. The objectives of our study were to compare the outcome of pyometra surgeries performed at referral hospitals with those performed at community clinics (outpatient settings), and to evaluate whether the duration between diagnosis and surgery or provision of postoperative care influenced outcome. Specifically, in cases with financial resource limitations, after a diagnosis of pyometra, it may be several days to even weeks before surgical care can be negotiated at a subsidized rate. In addition, because the cost of supportive care in a 24-hour hospital adds to the cost of care, we wished to evaluate the impact of same-day discharge on outcome. Last, we wanted to examine whether having an inexperienced surgeon (trainee) affected outcome.
This project was made possible thanks to an Access to Care research grant from the American Society for the Prevention of Cruelty to Animals (ASPCA). Dr. Pailler is an ASPCA research team member and contributed to the design and analysis of this project. The authors declare there were no conflicts of interest.
The research team is grateful to Kelly Gleason, CVT, for assistance with data collection.
- 3. ↑
Jitpean S, Holst BS, Höglund OV, et al. Serum insulin-like growth factor-1, iron, C-reactive protein, and serum amyloid A for prediction of outcome in dogs with pyometra. Theriogenology. 2014;82:43–48.
- 4. ↑
Pelander L, Hagman R, Häggström J. Concentration of cardiac troponin I before and after ovariohysterectomy in 46 female dogs with pyometra. Acta Vet Scand. 2008;50:35
Dorsey TI, Rozanski EA, Sharp CR, Babyak JM, de Laforcade AM. Evaluation of thromboelastography in bitches with pyometra. J Vet Diagn Invest. 2018;30:165–168.
- 6. ↑
Hagman R, Reezigt BJ, Bergström Ledin H, Karlstam E. Blood lactate levels in 31 female dogs with pyometra. Acta Vet Scand. 2009;51:2–3.
- 7. ↑
Liao PY, Chang SC, Chen KS, Wang HC. Decreased postoperative C-reactive protein production in dogs with pyometra through the use of low-dose ketamine. J Vet Emerg Crit Care (San Antonio). 2014;24:286–290.
- 8. ↑
Jitpean S, Ström-Holst B, Emanuelson U, et al. Outcome of pyometra in female dogs and predictors of peritonitis and prolonged postoperative hospitalization in surgically treated cases. BMC Vet Res. 2014;10:6
- 9. ↑
Benka VA, McCobb E. Characteristics of cats sterilized through a subsidized, reduced-cost spay-neuter program in Massachusetts and of owners who had cats sterilized through this program. J Am Vet Med Assoc. 2016;249:490–498.
- 10. ↑
Stull JW, Shelby JA, Bonnett BN, et al. Barriers and next steps to providing a spectrum of effective health care to companion animals. J Am Vet Med Assoc. 2018;253:1386–1389.
- 11. ↑
Access to Veterinary Care Coalition. Access to Veterinary Care: Barriers, Current Practices, and Public Policy; 2018. Accessed March 1, 2022. https://pphe.utk.edu/wp-content/uploads/2020/09/avcc-report.pdf
- 12. ↑
McCallin AJ, Hough VA, Kreisler RE. Pyometra management practices in the high quality, high volume spay-neuter environment. Top Companion Anim Med. 2021;42:100499
- 13. ↑
Griffin B, Bushby PA, McCobb E, et al. The Association of Shelter Veterinarians’ 2016 veterinary medical care guidelines for spay neuter programs. J Am Vet Med Assoc. 2016;249:165–188.
- 14. ↑
Pailler S, Slater M, Lesnikowski S, et al. Findings and prognostic indicators of outcomes for bitches with pyometra treated surgically in a nonspecialized setting. J Am Vet Med Assoc. In press.
- 15. ↑
Kreisler RE, Shaver SL, Holmes JH. Outcomes of elective gonadectomy procedures performed on dogs and cats by veterinary students and shelter veterinarians in a shelter environment. J Am Vet Med Assoc. 2018;253:1294–1299.