Outcomes of dogs undergoing surgery for gastric dilatation volvulus after rapid versus prolonged medical stabilization.

Abstract

To compare the outcomes of dogs surgically treated for gastric dilatation volvulus (GDV) after rapid versus prolonged medical stabilization. Prospective cohort study, monoinstitutional. One hundred and sixty-two dogs with GDV. Dogs presenting with a GDV were allocated to 1 of 2 groups, immediate or delayed. In the immediate group, dogs were stabilized for 90 min prior to undergoing surgery. In the delayed group, dogs underwent surgery after at least 5h of stabilization. Medical stabilization included gastric decompression and placement of an indwelling nasogastric tube to prevent further gastric dilatation in all dogs. Short-term outcomes were compared between surgical timings by univariate and multivariate analyses. Dogs (n=89) in the immediate group underwent surgery a median time of 2.1h after presentation (range 1.9-2.5h), whereas those in the delayed surgery group (n=73) were operated a median time of 9.8h (range 5.4-13.7h) after presentation. Survival rates did not differ between dogs undergoing immediate or delayed surgery at discharge (70/89 and 60/73, respectively) or at 1 month postoperatively (68/89 and 55/73, respectively). The degree of gastric torsion was differently distributed between the 2 groups (P=.05). In the immediate group, 19, 52, and 9 dogs had a 0°, 180° and 270° gastric torsion respectively, whereas in the delayed group, 27, 32, and 5 dogs had a 0°, 180° and 270° gastric torsion respectively. Hyperlactatemia 24 h after initiation of fluid therapy was associated with an increased in-hospital mortality risk and at 1 month postoperatively. No survival benefit was detected as a result of proceeding to surgery after either a rapid or a prolonged medical stabilization. The aggressive stabilization and monitoring protocol described here can be considered as an alternative to stabilize dogs with GDV prior to surgery within 13.7h of presentation. Further research is required to investigate the potential risks and benefits of prolonged over rapid stabilization and to identify candidates for each approach.