A multi-centre cohort study investigating the outcome of synovial contamination or sepsis of the calcaneal bursae in horses treated by endoscopic lavage and debridement.

Autor: Isgren CM; Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.; Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Wirral, UK., Salem SE; Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Wirral, UK.; Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt., Singer ER; Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK., Wylie CE; Rossdales Equine Hospital, Exning, Newmarket, Suffolk, UK., Lipreri G; Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK., Graham RJTY; The Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Midlothian, UK., Bladon B; Donnington Grove Veterinary Group, Newbury, Oxfordshire, UK., Boswell JC; The Liphook Equine Hospital, Forest Mere, Liphook, Hampshire, UK., Fiske-Jackson AR; Equine Referral Hospital, Royal Veterinary College, North Mymms, Hertfordshire, UK., Mair TS; Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent, UK., Rubio-Martínez LM; Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.; Sussex Equine Hospital, West Sussex, UK.
Jazyk: angličtina
Zdroj: Equine veterinary journal [Equine Vet J] 2020 May; Vol. 52 (3), pp. 404-410. Date of Electronic Publication: 2019 Oct 16.
DOI: 10.1111/evj.13180
Abstrakt: Background: Previous studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited.
Objectives: To investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections.
Study Design: Retrospective analysis of clinical records.
Methods: Medical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow-up questionnaire was used to determine survival and return to athletic performance. Descriptive statistics and Cox proportional hazards survival models were used to determine factors associated with survival.
Results: Horses underwent one (n = 107), two (n = 19), or three (n = 2) surgeries. Survival to hospital discharge was 84.4%. Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (hazard ratio, [HR] 0.41, 95% CI 0.18-0.91, P = 0.03). Increased mortality was associated with bone fracture/osteomyelitis (HR 2.43, 95% CI 1.12-5.26, P = 0.03), tendon involvement (≥30% cross sectional area) (HR 3.78 95% CI 1.78-8.04, P = 0.001), duration of general anaesthesia (HR 1.01, 95% CI 1.00-1.02, P = 0.04), post-operative synoviocentesis (HR 3.18, 95% CI 1.36-7.43, P = 0.006) and post-operative wound dehiscence (HR 2.5, 95% CI 1.08-5.65, P = 0.04). Multivariable Cox proportional hazards model revealed reduced mortality after systemic antimicrobial administration prior to referral (HR 0.25, 95% CI 0.11-0.60, P = 0.002) and increased mortality with tendinous involvement (≥30% cross-sectional area) (HR 7.92, 95% CI 3.31-19.92, P<0.001). At follow-up (median 30 months, range 0.25-13 years, n = 70) 87.1% horses were alive, 7.1% had been euthanised due to the calcaneal injury and 5.7% had been euthanised for unrelated reasons. From 57 horses with athletic performance follow-up, 91.2% returned to the same/higher level of exercise, 5.3% to a lower level and 3.5% were retired due to persistent lameness of the affected limb.
Main Limitations: Retrospective study and incomplete follow-up.
Conclusion: Endoscopic treatment of contamination/sepsis of the calcaneal bursae has an 84% survival rate to hospital discharge. Tendinous involvement reduced survival whilst systemic antimicrobials administration prior to referral improved survival.
(© 2019 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.)
Databáze: MEDLINE
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