Evaluation of Cosmetic Results of Surgical Wound Closure in Dogs

Abstract

Objective: To evaluate the correlation between wound cosmesis and pet owner satisfaction, to determine the agreement among vet surgeons, and pet owners evaluating a surgical wound with a visual assessment score (VAS), and to determine the agreement between the VAS, a semi-quantitative score of wound inflammation, and wound width. Background: Perception of post-surgical cosmesis by human patients has been found to influence their satisfaction and perceived adequacy of vet surgeons. Due to the trend of owners anthropomorphising pets, this logic can be extended to veterinary patients. Also, there is a lack of consistent, reliable methods to evaluate cosmesis have been developed, creating the need for a scoring system that is accurate and reproducible. Evidentiary value: This was a prospective cohort study with one hundred and seven patients. This study may not change day-to-day practices, but it will bring to light for practitioners the discordance between pet owners and vet surgeons concerning attractiveness of an incision as well as overall satisfaction with a procedure. Methods: Photographs of surgical wounds were taken immediately, 2 weeks, and 8 weeks after surgery in dogs. Owners were asked to evaluate satisfaction with the procedure and attractiveness of the incision using the VAS. Photos were evaluated for cosmetic outcome by pet owner and vet surgeon evaluators with different scoring systems. The reliability of the scoring systems was evaluated using intraclass correlations and kappa statistics as appropriate. Results: Owners’ evaluation of cosmetic outcome correlated with their overall satisfaction. (r 2 =0.37, where r 2 is the coefficient of determination, and can be used to determine what proportion of variance in one variable is predictable from the other variableThere was generally poor reliability of the subjective scoring between both vet surgeons and pet owners, and the less subjective scoring systems. Conclusion: The cosmetic outcome as judged by the owner accounted for 37% of the variability in satisfaction, that is to say that 37% of the total variation in satisfaction could be explained by the cosmetic outcome as evaluated by the owner. This suggests that wound cosmesis significantly influences clients’ satisfaction. However, the other methods of rating cosmesis evaluated in this study were unreliable. Application: The results of this study are relevant to all veterinarians in clinical practice, from general practice to tertiary referral centers. This study should be kept in mind when speaking with owners to establish pre-surgical expectations as well as mediating conflict due to a difference in opinion with regards to a surgical outcome.