Evaluation of a client questionnaire at diagnosing surgical site infections in an active surveillance system.

OBJECTIVE: To report sensitivity, specificity, predictive values and accuracy of a client questionnaire at diagnosing surgical site infections (SSIs) and describe the impact of active surveillance on SSI detection. STUDY DESIGN: Prospective, cohort study. ANIMALS: Dogs and cats undergoing soft tissue or orthopedic surgery over a 12-month period at a referral hospital. METHODS: Clients were emailed a questionnaire 30 days postoperatively, or 90 days where an implant was used. Three algorithms were developed to diagnose SSIs using one or both of two criteria: (1) presence of any wound healing problems; (2) wound dehiscence or antibiotic prescription, and either purulent discharge or two or more clinical signs (redness, pain, heat, swelling, discharge). Algorithmic diagnoses were compared to gold standard diagnoses made by veterinarians. RESULTS: Of 754 surgical procedures, 309 responses were completed with 173 corresponding gold standard diagnoses. The most accurate algorithm determined "SSI" or "No SSI" from 90.2% of responses with 95.5% (92.4-98.6) accuracy, 82.6% (77-88.3) sensitivity, 97.7% (95.5-100) specificity, 86.4% (81.2-91.5) positive predictive value, and 97% (94.5-99.6) negative predictive value. "No SSI" was diagnosed in responses not meeting criterion 1, and "SSI" in responses meeting criteria 1 and 2. "Inconclusive" responses, comprising 9.8% of responses, met criterion 1 but not 2. Overall SSI rate was 62/754 (8.2%) and 12/62 (19.4%) SSIs were detected by active surveillance only. CONCLUSION: Use of this client questionnaire accurately diagnosed SSIs; active surveillance increased SSI detection. CLINICAL SIGNIFICANCE: Surveillance of SSIs should be active and can be simplified by using a client questionnaire and algorithmic diagnoses, allowing automated distribution, data collection and analysis.

Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs: A review.

The development of postattenuation neurologic signs (PANS) is a poorly understood and potentially devastating complication after surgical attenuation of congenital portosystemic shunts in dogs. Postattenuation neurologic signs include seizures but also more subtle neurologic signs such as depression, behavioral changes, tremors, and twitching. They most commonly occur within 7 days postoperatively and are typically unrelated to hyperammonemia, hypoglycemia, or electrolyte disturbances. This narrative review summarizes the findings of 50 publications from 1988-2020 that report occurrence of PANS. While most published reports included only dogs affected by postattenuation seizures (PAS), others included dogs with any form of PANS. Overall, PANS (including PAS) affected 1.6%-27.3% of dogs, whereas incidence of PAS ranged from 0%-18.2%. The etiology of PANS remains unknown; however, several theories have been proposed. Risk factors include preoperative hepatic encephalopathy, increasing age, and possibly certain breeds and extrahepatic shunt morphology. There is increasing evidence that prophylactic antiepileptic drugs do not prevent PANS. Treatment is centered around controlling neurologic signs with antiepileptic drugs and providing supportive intensive care. The 30-day survival rate in studies that included a minimum of four dogs affected by PANS was 0%-100% (median, 50.0%) and 0%-75.0% (median, 37.5%) for those with PAS. Mortality associated with PANS was typically related to occurrence of generalized seizure activity. Prognostic factors positively associated with short-term survival included having a history of preoperative seizures and development of focal seizures only. If affected dogs survived to discharge, survival for several years was possible, and the majority of neurologic signs manifested as part of the phenomenon of PANS appeared to resolve.

Prognostic factors for short-term survival of dogs that experience postattenuation seizures after surgical correction of single congenital extrahepatic portosystemic shunts: 93 cases (2005-2018).

OBJECTIVE: To identify prognostic factors for short-term survival of dogs that experience seizures within 7 days after surgical correction of single congenital extrahepatic portosystemic shunts (cEHPSS). STUDY DESIGN: Multi-institutional retrospective study. SAMPLE POPULATION: Ninety-three client-owned dogs. METHODS: Medical records at 14 veterinary institutions were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 1, 2005 through February 28, 2018 and experienced postattenuation seizures (PAS) within 7 days postoperatively. Logistic regression analysis was performed to identify factors associated with 1-month survival. Factors investigated included participating institution, signalment, shunt morphology, concurrent/historical conditions, presence of preoperative neurologic signs, presence of preoperative seizures, aspects of preoperative medical management, surgical details including method and degree of shunt attenuation, type of PAS (focal only or generalized ± focal), drugs administered as part of the treatment of PAS, and development of complications during treatment of PAS. RESULTS: Thirty (32.3%) dogs survived to 30 days. Seventy-six (81.7%) dogs experienced generalized PAS. Factors positively associated with short-term survival included having a history of preoperative seizures (P = .004) and development of focal PAS only (P = .0003). Most nonsurvivors were humanely euthanized because of uncontrolled or recurrent seizures. CONCLUSION: Dogs that experienced PAS that had a history of preoperative seizures and those that experienced focal PAS only had significantly improved short-term survival. CLINICAL SIGNIFICANCE: The results of this study provide information that will help in the counseling of owners who seek treatment for PAS after surgical correction of cEHPSS. © 2020 The American College of Veterinary Surgeons.

Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts.

OBJECTIVE: To report the incidence of postattenuation seizures (PAS) in dogs that underwent single congenital extrahepatic portosystemic shunt (cEHPSS) attenuation and to compare incidence of PAS in dogs that either did or did not receive prophylactic treatment with levetiracetam (LEV). STUDY DESIGN: Multi-institutional retrospective study. POPULATION: Nine hundred forty dogs. METHODS: Medical records were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 2005 through July 2017 and developed PAS within 7 days postoperatively. Dogs were divided into 3 groups: no LEV (LEV-); LEV at ≥15 mg/kg every 8 hours for ≥24 hours preoperatively or a 60 mg/kg intravenous loading dose perioperatively, followed by ≥15 mg/kg every 8 hours postoperatively (LEV1); and LEV at <15 mg/kg every 8 hours, for <24 hours preoperatively, or continued at <15 mg/kg every 8 hours postoperatively (LEV2). RESULTS: Seventy-five (8.0%) dogs developed PAS. Incidence of PAS was 35 of 523 (6.7%), 21 of 188 (11.2%), and 19 of 228 (8.3%) in groups LEV-, LEV1, and LEV2, respectively. This difference was not statistically significant (P = .14). No differences between groups of dogs that seized with respect to investigated variables were identified. CONCLUSION: The overall incidence of PAS was low (8%). Prophylactic treatment with LEV according to the protocols that were investigated in our study was not associated with a reduced incidence of PAS. CLINICAL SIGNIFICANCE: Prophylactic treatment with LEV does not afford protection against development of PAS. Surgically treated dogs should continue to be monitored closely during the first 7 days postoperatively for seizures.

Use of a split-thickness soft palate hinged flap and bilateral buccal mucosal rotation flaps for one-stage repair of a bilateral hypoplastic soft palate in a dog.

CASE DESCRIPTION: A 14-week-old 8.5-kg (18.7-lb) sexually intact female Springer Spaniel was evaluated because of chronic rhinitis with bilateral mucopurulent nasal discharge. The dog had a history since birth of sneezing and oronasal reflux of food and liquid. CLINICAL FINDINGS: Oral examination under anesthesia revealed a short, incompletely formed soft palate with bilateral clefts. A pseudouvula was not a prominent feature of the condition in this dog. TREATMENT AND OUTCOME: The dog underwent 1-stage reconstruction of the soft palate by means of a split-thickness soft palate hinged flap and bilateral buccal mucosal rotation flaps. Long-term follow-up obtained 3 years after surgery revealed the dog to be in good general health, with resolution of oronasal reflux; however, occasional episodes of mild sneezing and nasal discharge persisted. Oral examination under sedation revealed attenuation of the bilateral clefts; however, a normal soft palate length was not achieved. CLINICAL RELEVANCE: Compared with previously described techniques, this technique offered the possibility of 1-stage reconstruction of the soft palate in dogs, rather than having 2 staged procedures performed, and a robust tissue combination that was expected to be less prone to trauma. This technique may be particularly suitable for affected dogs where a pseudouvula is not a prominent feature and appears to be applicable to a variety of skull morphologies. Owners should be made aware that the absence of normal palatine muscle within the reconstructed palate may affect function, but even where normal function is not regained, a good quality of life with minimal clinical signs may be achieved.

Evaluation of a modified proportional margins approach for surgical resection of mast cell tumors in dogs: 40 cases (2008-2012).

OBJECTIVE: To evaluate a modified proportional margins approach to resection of mast cell tumors (MCTs) in dogs. DESIGN: Retrospective case series. ANIMALS: 40 dogs with subcutaneous and cutaneous MCTs undergoing curative intent surgery. PROCEDURES: Medical records were searched to identify dogs with a cytologically or histologically confirmed diagnosis of MCT that had not previously been treated surgically and that had undergone full oncological staging. In those dogs, tumors were resected with lateral margins equivalent to the widest measured diameter of the tumor and a minimum depth of 1 well-defined fascial plane deep to the tumor. Surgical margins were evaluated histologically. Cutaneous tumors were graded by use of the Patnaik system and the 2-tier system described by Kiupel et al. The prognosis for subcutaneous tumors was assessed in accordance with published recommendations. Follow-up information on dog health status was obtained through clinical examination, the dog owners, and the referring veterinarians. RESULTS: The 40 dogs had 47 tumors. Forty-one (87%) tumors were cutaneous, and 6 (13%) were subcutaneous. On the basis of the Patnaik system, 21 (51%) cutaneous tumors were considered grade I, 18 (44%) were considered grade II, and 2 (5%) were considered grade III. On the basis of the Kiupel system, 37 (90%) cutaneous tumors were considered low grade, and 4 (10%) were considered high grade. The prognosis for the 6 subcutaneous tumors was classified as likely resulting in a shorter (2) or longer (4) survival time. Forty tumors were deemed to have been excised with clear margins and 7 with incomplete margins. Local recurrence was not recorded for any dog but was suspected for 1 (2%) tumor, although not confirmed. Interval from tumor excision to follow-up ranged from 30 to 1,140 days (median, 420 days). CONCLUSIONS AND CLINICAL RELEVANCE: The modified proportional margins system resulted in satisfactory local disease control in dogs with MCTs.

Chronic oesophageal foreign body in a cat.

An 11-year-old cat was presented with an approximately 2-month history of dysphagia, intermittent regurgitation and weight loss. An oesophageal foreign body was identified on plain radiographs, and an oesophagotomy was performed to remove a large V-shaped bone from the caudal cervical oesophagus. A gastrostomy feeding tube was placed to allow nutritional support postoperatively. Medical treatment for oesophagitis was initiated after surgery. No complications were encountered and the cat was discharged 4 days after surgery.

Inflammatory polyps of the middle ear in 5 dogs.

OBJECTIVE: To describe inflammatory polyps of the middle ear in 5 dogs. STUDY DESIGN: Case series. ANIMALS: Five dogs with ear disease. METHODS: Medical records (1995-2001) were reviewed to identify dogs with inflammatory polyps of the middle ear. Signalment, clinical signs, ancillary diagnostic procedures, treatment, postoperative complications, and outcome were recorded. Owners and referring veterinarians were contacted to document outcome. RESULTS: Dogs with inflammatory polyps of the middle ear were male and aged 4 to 13 years. Two dogs had bilateral polyps, whereas 3 had unilateral polyps. The most common clinical presentation was otitis externa and media, with radiographic evidence of otitis media. Polyps were treated by ventral bulla osteotomy (VBO) in 1 dog and total ear canal ablation with lateral bulla osteotomy (TECA-LBO) in 4 dogs. Polyps consisted of a fibrovascular stroma infiltrated with neutrophils, macrophages, lymphocytes, and plasma cells. The overlying epithelium was frequently ulcerated. Immediate postoperative complications included a seroma after VBO (1 dog) and transient unilateral facial nerve paralysis after bilateral TECA-LBO (1 dog). No recurrence occurred within 9 to 69 months. CONCLUSIONS: Unilateral or bilateral, inflammatory polyps can occur in the middle ear of dogs in association with otitis externa and media. No recurrence occurred after surgical removal of the polyps. CLINICAL RELEVANCE: Inflammatory polyps of the middle ear in dogs can be a cause of otitis externa/media. Surgical removal of aural polyps has a good prognosis.