Clinical features, comparative imaging findings, treatment, and outcome in dogs with discospondylitis: A multi-institutional retrospective study.

BACKGROUND: Limited recent data exists regarding discospondylitis in dogs. HYPOTHESIS/OBJECTIVES: (i) Describe the signalment, clinical and imaging findings, etiologic agents, treatment, and outcome of dogs with discospondylitis, (ii) determine diagnostic agreement between radiographs, CT, and MRI with regard to the presence of discospondylitis and its location, and (iii) determine risk factors for relapse and progressive neurological deterioration. ANIMALS: Three hundred eighty-six dogs. METHODS: Multi-institutional retrospective study. Data extracted from medical records were: signalment, clinical and examination findings, diagnostic results, treatments, complications, and outcome. Potential risk factors were recorded. Breed distribution was compared to a control group. Agreement between imaging modalities was assessed via Cohen's kappa statistic. Other analyses were performed on categorical data, using cross tabulations with chi-squared and Fisher's exact tests. RESULTS: Male dogs were overrepresented (236/386 dogs). L7-S1 (97/386 dogs) was the most common site. Staphylococcus species (23/38 positive blood cultures) were prevalent. There was a fair agreement (κ = 0.22) between radiographs and CT, but a poor agreement (κ = 0.05) between radiographs and MRI with regard to evidence of discospondylitis. There was good agreement between imaging modalities regarding location of disease. Trauma was associated with an increased risk of relapse (P = .01, OR: 9.0, 95% CI: 2.2-37.0). Prior steroid therapy was associated with an increased risk of progressive neurological dysfunction (P = .04, OR: 4.7, 95% CI: 1.2-18.6). CONCLUSIONS AND CLINICAL IMPORTANCE: Radiograph and MRI results could be discrepant in dogs with discospondylitis. Prior trauma and corticosteroids could be associated with relapse and progressive neurological dysfunction, respectively.

Virtual arthroplasty clinic: a single centre experience: commentary on progress, cost savings and patient retention.

BACKGROUND: The COVID pandemic highlights utility of remote patient follow-up. We observe a Virtual Clinic (VC) follow-up model for arthroplasty used at a metropolitan hospital. Patients aged <70 that exhibit no issues in face-to-face review (F2F) progress to VC. We aimed to review VC's cost-effectiveness, and identify potential improvements to patient allocation and retention. METHOD: A retrospective database was collated of all hip and knee joint arthroplasties performed at Frankston Hospital over a 12-month period in 2017-2018. Patient encounters were followed from operation to discharge from F2F and, if appropriate, VC (involving imaging and a paper-based qualitative questionnaire). VC attendance was compared to that of the year in which it was introduced (2014). The Clinical Costings Department provided average hospital spending for each of these modes of follow-up. RESULTS: Of 516 joint arthroplasties performed, 500 attended outpatient clinic (OPC). There were 884 F2F appointments (average 1.7 per person, range 0-12). One-hundred-and-fifty-four arthroplasties were correctly assigned to subsequent VC as per protocol (30%). Completed VC responses were received for 86 arthroplasties (56% response rate). In the period studied, VC attendance increased significantly compared to the year following introduction (36-56%, p < 0.05), with the questionnaire revealing a high-level of patient satisfaction for this method of follow-up. Over the period studied, we estimate VC has saved $250 000 and 300 review hours from OPC. CONCLUSION: Implementing VC for follow-up of arthroplasty may demonstrate a method of saving hospital resources. Appropriate early enrolment of patients to reduce F2F burden, and VC retention, should be encouraged.

Incidence, risk factors, and outcomes for early postoperative seizures in dogs with rostrotentorial brain tumors after intracranial surgery.

BACKGROUND: Seizures in the early postoperative period after intracranial surgery may affect outcome in dogs. OBJECTIVES: To determine the incidence of early postoperative seizures (EPS) in dogs with brain tumors, identify specific risk factors for EPS, and determine if EPS affects outcome. ANIMALS: Eighty-eight dogs that underwent 125 intracranial surgeries for diagnosis and treatment of rostrotentorial brain tumors. METHODS: Retrospective cohort study. All patients with a diagnosis of rostrotentorial brain tumor from 2006 to 2020 were included. Early postoperative seizures were diagnosed by observation of seizure activity within 14 days of neurosurgery. Previously diagnosed structural epilepsy, perioperative anticonvulsant drug (ACD) use, magnetic resonance imaging (MRI), and tumor characteristics were evaluated. Outcome measures included neurologic and nonneurologic complications, duration of hospitalization, and survival to discharge. RESULTS: Dogs with rostrotentorial brain tumors had EPS after 16/125 (12.8%) neurosurgical procedures (95% confidence interval [CI], 7%-19%). Presence of previous structural epilepsy was not associated with EPS risk (P = 1). Perioperative ACD use also was not associated with EPS (P = .06). Dogs with EPS had longer hospitalization (P < .001), were more likely to have neurologic complications postsurgery (P = .01), and were less likely to survive to discharge (P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE: It is difficult to predict which dogs are at risk of EPS because the presence of previous structural epilepsy and the use of perioperative ACDs was not associated with EPS. However, seizures in the early postoperative period are clinically important because affected dogs had prolonged hospitalization, more neurologic complications, and decreased short-term survival.