Effects of age, disease and anastomosis on short- and long-term survival after surgical correction of small intestinal strangulating diseases in 89 horses.

Abstract

Although survival rates have been reported after small intestinal surgery for strangulating diseases in horses, none have followed survival for periods relevant to the long lifespan of horses and none have described effect of age, disease and surgical treatments over such long survival periods. To examine effects of age, disease and type of surgery on long-term survival in horses after surgical treatment of small intestinal strangulating diseases over periods relevant to the expected lifespan of a horse. Retrospective clinical study. Post-operative data were gathered from medical records and owner contact for 89 horses with small intestinal strangulation. Survival times from surgery to the date of death or the date of last follow-up were analysed by Kaplan-Meier statistics. Variables of interest were age, type of strangulating disease and surgical correction. Cox proportional hazards regression was used to evaluate these variables. Short-term survival was not affected by any of the variables measured. For long-term survival with Kaplan-Meier statistics, horses ≥16years old had significantly shorter (P=.002) median survival times (72months; 95% CI 32.0-96.0) than younger horses (121.7months; 95% CI 90.0-162), horses without resection had significantly longer (P=.02) survival times (120months; 95% CI 86-212) than horses that had jejunocecostomy (76.8months; 95% CI 24-125), and horses with miscellaneous diseases had significantly longer (P=.02) median survival times (161.9months; 95% CI 72.0-M) than horses with strangulating lipoma (79.8months; 95% CI 32.0-120.0). In the multivariable Cox Proportional Hazard model, age (HR=2.67; 1.49-4.75, P<.001) and anastomosis (HR=0.65; 0.46-0.92, P=.02) had the most significant effect on median survival time. Limitations were small numbers in some categories, loss of cases to follow-up, owner recall failures and lack of a control group. The remaining lifespan of older horses at the time of surgery had the greatest effect on survival. Age could influence long-term survival studies after colic surgery, and therefore needs to be considered for survival analyses. Horses that did not require resection and anastomosis had favourable outcomes, underscoring the potential importance of early intervention to reduce the need for resection.