Just 20 years ago, overall equine survival of surgical colic hovered at 39-48% due to anesthetic complications and breakdown of surgical incisions. Recent overall survival rates range from 55-95%, dependent on timely intervention and clinician/hospital experience. Barbara Dallap Schaer, VMD, Dipl. ACVS, ACVECC, assistant professor of Emergency Medicine and Critical Care at the University of Pennsylvania's New Bolton Center, addressed changes in equine surgical and postoperative care at the 2009 American Association of Equine Practitioners (AAEP) convention, held Dec. 5-9 in Las Vegas, Nev.

Veterinarians using diagnostics such as abdominal ultrasound now can identify surgical conditions earlier, even in the absence of rectal exam findings. An abdominocentesis (belly tap) has been a helpful tool to diagnose the presence of abdominal infection (peritonitis) or ruptured bowel. Also, veterinarians can diagnose strangulating intestinal lesions by detecting increased lactate in peritoneal fluid. She noted that in humans, timely intervention relies on treatment in less than six hours; there are even better results if treatment starts less than two hours after diagnosis.

Regarding surgery, Schaer noted that the collective increase in surgical experience and advances in techniques in handling bowel resection have increased survival rates. Bowel bypass procedures have improved survivability; 69% of foals who underwent the procedure survived past two years, and adult survival following large colon resections has risen to nearly 58%. While adhesions used to be a common postoperative sequel to colic surgery, current intra-operative methods minimize their formation.

Schaer noted that postoperative management has taken great strides with improved patient monitoring, stabilization of cardiovascular status, and careful monitoring of coagulation profiles (clot formation). It's important to provide nutritional support following surgery, taking steps to control blood glucose and triglycerides to avoid or manage sepsis (infection of the blood). Improving intestinal motility with lidocaine has been instrumental in postoperative colic success. In general, broad-reaching, goal-directed therapy has reduced organ failure and mortality; consequently, undertaking such measures is financially justified.

Advances have also been made in managing musculoskeletal trauma. Researchers have improved techniques for identifying if a laceration has involved a synovial structure and necessitates aggressive lavage and possible arthroscopic/tenoscopic surgery. The outcome is best if the horse is referred within the initial 24 hours following injury. Regional limb perfusion allows antibiotic penetration directly into a targeted infection site. Veterinarians are now able to stabilize fractures or unstable soft tissue injuries better for transport. Recovery following musculoskeletal surgery is safer with the use of a pool-raft system to avoid further trauma, and horses with serious injuries can be supported with an Anderson sling to reduce cyclic loading of both the injured and supporting limbs. Pain management has improved with the use of epidural drugs.

Schaer stressed that the referring veterinarian plays a huge role in success or failure of a surgical outcome, whether it be colic or musculoskeletal. Rapid and timely referral for surgery, counseling of the horse owner as to expectations, and follow-up postoperative care and communication are key functions of referring practitioners. She stressed that many practitioners have acquired improved knowledge and advanced training to help them decide which cases should be referred for emergency critical care. Schaer maintains that respectful partnerships between referring veterinarians and referral clinicians have vastly improved patient management and case outcome.

About the Author

Nancy S. Loving, DVM

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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