Gill Sukhjit S, Buote Nicole J, Peterson Nathan W, Bergman Philip J
J Am Vet Med Assoc. 2019 Sep 1;255(5):569-573. doi: 10.2460/javma.255.5.569.
To identify factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs.
170 client-owned dogs that underwent gastrointestinal surgery from 2010 to 2016.
Medical records of all included dogs were reviewed to collect information on preoperative (breed, sex, age, body weight, American Society of Anesthesiologists [ASA] physical status classification, emergency status, and plasma lactate concentration), intraoperative (indication for surgery, type of surgery, and whether bacterial peritonitis was identified), and postoperative (development of dehiscence and survival status at 2 weeks after surgery) factors. Preoperative and intraoperative factors were evaluated for associations among each other and with postoperative factors.
Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L). Multivariate analysis controlling for age, body weight, and plasma lactate concentration revealed that dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06). Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs.
These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis.
确定与犬类胃肠手术后切口裂开和死亡率相关的因素。
2010年至2016年接受胃肠手术的170只客户拥有的犬。
回顾所有纳入犬的病历,收集术前(品种、性别、年龄、体重、美国麻醉医师协会[ASA]身体状况分级、急诊状态和血浆乳酸浓度)、术中(手术指征、手术类型以及是否发现细菌性腹膜炎)和术后(切口裂开的发生情况和术后2周的生存状态)因素的信息。评估术前和术中因素之间以及与术后因素的相关性。
单因素分析显示,术前血浆乳酸浓度随ASA分级增加而升高,非存活犬(均值±标准差,4.6±3.7 mmol/L)的乳酸浓度显著高于存活犬(2.4±1.7 mmol/L)。在控制年龄、体重和血浆乳酸浓度的多因素分析中,ASA分级≥3的犬比ASA分级较低的犬在胃肠手术后更易发生切口裂开(比值比,17.77;95%置信区间,2.17至144.06)。多因素分析还显示,ASA分级≥3或乳酸浓度高的犬比其他犬存活的可能性更小。
这些关于ASA分级和术前血浆乳酸浓度及其与预后的相关性的发现,可能有助于临床医生为需要胃肠手术的犬确定并提供最佳围手术期护理,并告知主人预后情况。