So welcome to this Webinar. And I've given some, updates on, colic surgery and certainly around diagnosis before. But I thought it might be useful for, vets to get an update on where we're up to with looking at outcomes and not that's not just from the perspective of a vet, but also, from horse owners.
So just to give you an outline of, what we're going to cover today, and, some of the learning objectives, from this I'm not gonna read these all out, but I'm gonna run through some of the key, features that we know around, survival of horses that have undergone colic surgery and to go through, clinical audit and its role with, horses undergoing colic. Particularly for those who, might not be familiar with clinical audit and to go through some results of, an audit that we've done, some features of, clinics, around the world that offer colic surgery and some of the key, similarities and differences between them. And I guess what?
A vet and an owner want to know is you know what is the likely outcome. For horses undergoing colic surgery. And that might be, you know, for specific, types of colic, or at a clinic level.
You know, a clinic might want to compare themselves in terms of their outcomes compared to, the results from other clinics. OK, so I'm sure many of you are familiar with, colic in horses. It is something that, strikes fear.
I think it would be fair to say, in in many owners, they, some, compare it to the word cancer, which is perhaps a little bit over dramatic. But from a horse owner perspective, if they get that call to say that their horses got colic, they know that it could potentially, have really serious and potentially fatal, implications. And we know that colic remains one of the most common causes of death in, horses that are kept, sort of managed for the purposes of us, using them for for pleasure.
And, for for economic purposes. So sport, sport horses. And we know that, educating our horse owners is is really important.
And, it's not always a given that horse owners will know what the signs of colic are. So it's really important that they're aware of those signs, but also what to do if a horse is showing signs of colic. And we know that, there's no one size fits all.
All owners are very different. We rely on them to, contact us as, veterinary professionals to get advice. And different types of horse owners have different reactions, which may range from total panic to, refusing to believe that, something serious might be going on.
So as a veterinary professional, we have to be able to communicate with these owners and tailor our communication to different types of horse owners. But importantly, horse owners like us to provide some answers to questions that they may have, and particularly around, you know what might happen with their horse. And we know from the results of surgery, you know, we have a pretty good idea of, you know, outcomes for for colic cases.
We also know what horses are more likely to get colic. How we might be able to prevent it. And again, having that evidence based information is important.
It empowers us as veterinary professionals having those discussions with owners. But also it allows owners to make informed decisions for themselves. And as I've gone through in previous, presentations around, colic, I think one of the challenges is, identifying that horse that might need surgery at the earliest possible stage.
And, you know, there have been developments, in colic surgery, and how we look after horses. But the basic principle is that when we're assessing a horse with colic, it's really important that we have, a logical, approach. And it doesn't need to be based on anything particularly fancy.
Necessarily, a thorough, general clinical examination to try to get an idea of how severe, or not. A colic episode may be colic, severity, and findings of, our examinations, including potentially, rectal examination or passing a stomach tube, but importantly response to, analgesia are all gonna be really, key in helping us to work out if that is one of those more, severe cases that we're dealing with. And we know that over the years we've been able to improve our ability to diagnose, potential surgical cases at an early stage.
And I'd say that, you know, certainly those, techniques that can be All those tests that can be used by vets in the field are very relevant, and more accessible, to, veterinary professionals. And that would include, abdominal ultrasonography, and laboratory tests to look at biomarkers that might help us to work out how severe a case is, and key of these, for example, would be, measurement of, systemic or peritoneal lactate, which can again be done stable sides with, portable, testing devices that are quite common. And, epidemiological studies and looking at survival of colic cases.
We know that early surgery is really important by the time we're getting to horses that are really sick and have got very elevated, heart rates or packed cell volume, the chances of that horse dying. increase. So what we have to do is try to, identify those cases at the earliest stage before they start to become systemically, sick.
If we're going to get the best outcomes for that case. So in terms of assessing, colic severity, I think a key thing is that, we don't need to get too hung up on, the actual diagnosis. And, you know, particularly in these early surgical cases, you might not have all the information that you need to make a a true, diagnosis.
You might have an idea from some of the risk factors, for colic, and particular types of colic. But, that isn't really important. What we as vets in the field need to be able to do is, work out which of these horses are the ones that are worrying us a little bit more.
And we know from the results of studies that, around about one in 10, colic cases seen in first opinion practise, will be surgical in nature. That is, they either require surgical intervention, or if surgery isn't an option, they would be cases that would be euthanased on humane grounds. But some, results of, research done, in first opinion practise in the UK.
Actually, showed that, a greater proportion of horses actually had, were were termed more sort of critical cases. That is horses that, needed, some form of hospital evaluation and monitoring. And that was around about a quarter of cases of, colic Seen, in first opinion, practise.
Obviously, this is within the UK and could be different within, different populations. But, you know, that's a a reasonable proportion of cases. And as I mentioned, you don't need to have any fancy equipment.
It's the basic, principles of, physical examination, including assessment of degree of pain and heart rates and pulse quality and perfusion. And those, cases that are more critical. Are those with, increasing, pain scores.
You can see here. I've given you some odds ratios. These, for those who aren't familiar with odds ratios, for every sort of increase in the pain score here, the likelihood that a colic case is more critical, goes up, heart rate again.
Same. So that incremental as the heart rate goes up, they're much more likely to be critical, but having an altered capillary refill time, if it looks really obviously abnormal, is certainly. those horses are around three times more likely to be critical in nature or those with a very, weak pulse And where there's, a loss of, gut Sands in the quadrant.
So, as I said, nothing particularly fancy here, and I guess some might say a little bit common sense. But, the advantage of doing, these sort of epidemiological studies is that we can start to quantify it, which helps us with our decision making, but also allows us to communicate that to owners when we're trying to give them all the information that they need to make an informed decision. And that decision to send a horse, for potential surgery or even, clinic admission can be a a quite challenging decision for horse owners.
And, because colic, can come on very quickly, and horses can deteriorate rapidly. Horse owners don't often have an awful lot of time to process that information. And, it can be at, as I'm sure many of you will know at, you know, times of the day, you know, in the middle of the night, decision making isn't isn't as easy as it might be, particularly for a horse owner who isn't expecting to have to make major decisions about their horse.
And we know that, you know, from a horse owner perspective, you know, the costs of colic surgery, and horse owner perceptions around, you know, whether colic surgery is worth it. You know how horses do afterwards are major, factors that they need to take into account when making that decision. And also there may be other factors.
So, for example, a horse that's got concurrent comorbidities so issues with ongoing lameness or other major medical problems. It might be that, that tips the balance. For that case, away from, going for colic surgery.
As I've already mentioned, it's really important as veterinary professionals. You know, owners, expect us to be able to provide them, with information based on, some form of, fact to to help them make, those decisions And certainly what from an owner and vet perspective, is most pressing is what is the likely outcome for that horse following, colic surgery. And I suppose as a vet in the field you may be making decisions about, you know, a a clinic, you know, which clinic are you going to send that horse to, is, a case more likely to have a better outcome at one clinic.
Compared to another. So how do we measure? Surgical outcomes And certainly, some, work that was done by within, the equine, surgery field by, Tim, me and and Nat White.
A number of years ago identified colic surgery in particular as being a A really, ideal area to audit, the results of our surgical interventions. And, you know, what can we expect in terms of success rates, across a range of clinics and actually, to date, there's AAA lack of what we call benchmarks. So those are comparisons.
With which, clinics can, assess their own, outcomes. Or an owner can can look at outcomes. And we know from published data that we do have some, information around success rates.
But these, published data are actually quite limited, to, a small number of clinics and particularly those in, North America and, parts of, Europe with actually very little results from other geographic regions. So why would we want to measure, surgical outcomes? Well, we always want to do better.
And if we don't know, how we're doing, it's difficult to to judge whether we need to, improve or not. Or are we doing OK? And that might be overall from, you know, the perspective of, colic surgeons, you know, looking at, general techniques, to manage a particular type of lesion or, you know, anastomosis or the clinic teams.
They may want to, check to see how they're doing to see if there's, changes that need to be made, But it's not always a negative thing. And actually, just as important is identifying areas where we do really well. And where we identify those, sharing best practise.
So that, other, clinics, can benefit from that. So, in terms of clinical audit, what is it? Well, some of you may be quite familiar around this, and, you know, it's an area where, particularly within the UK and, the Royal College of Veterinary Surgeons.
Have a really, great range of, resources, videos and, clinical audits, templates that you can use to do clinical audit within your own, practise settings. And it's all around what we term quality improvement. So this is a process that improves patient care and outcomes by looking at, the results of, set criteria and where required putting, changes in place.
So, the bottom corner shows, what we call the audit cycle. And again, clinical audit isn't something. I'm going to go into a huge amount of detail in this presentation.
But again, if you're, wanting, to read more about this, I'd highly recommend looking at those, R, CBS, audits, materials that are available to have a look at They're, free of charge and, available for all access. So looking at the human field, actually, quality improvement and and clinical, order is mandatory, particularly, in in the UK, within the, National Health Service. And very relevant to colic surgery would be, the national, emergency laparotomy.
Audit kneeler. That was started a number of years ago. It's now, in its, I presume eighth, iteration.
They, published the results of their, seventh. A relatively recently. And what this enables, people to do is, either from a medical, professional.
you know, look at the benchmarks, that have been established. But also from a patient, perspective. You know what?
You would expect from, medical interventions. For those people who need to have an emergency laparotomy, and, as you can see here from the summary, they do really nice. summaries of the key outcomes.
and areas for, improved, outcomes and, aware future audit will be focused. So what I'm gonna do in the rest of this presentation is give you some details around the in size project. to give you some of the most up to date, details around, some of the, benchmarks.
And, you know, outcomes that we might expect, following colic surgery. So this was a project that we set up at the University of Liverpool in 2019. Very well timed, data collection was due to start, at, in in early 2020 just as covid hit which, did alter plans.
Somewhat. But we did manage to get, data collected through 2020 2021. I'm very grateful to the the clinics, so as, you can understand, covid, provided clinics with a number of challenges.
and collecting data for a project like this probably wasn't a big priority. But, it was important to get, data collected so that we could, generate these, benchmarks. So this was a a Web based, portal, where we provided clinics with a confidential user name and login that only they and the in inside team knew so that clinics could enter their own colic case data, but importantly that they could access their own data, to be able to download it, for their own purposes.
including, an automatic, means of generating, audit reports. And, just so you can see at the bottom. The the little icon, you might be wondering, what that was.
Yes, that's a V un lipoma. as the sort of the the the basis for, this whole project. So what were we trying to do?
Well, look at quality of care and outcomes for horses. Following, colic surgery with the aim to, establish, you know where we're doing well, and maybe areas that we can focus on to improve outcomes. And, the web portal, is still there.
If you, want to, have a look for further information. So we had, phases one and two of this project in the first phase. We actually, asked clinics to provide some, details about what type of organisation they were.
So we looked across, private practises and academic clinics, but also looked at other, factors such as the number of, colic cases. They saw, and, you know what type of staff? They had it was quite an extensive, questionnaire.
And then in the second phase of it, we asked clinics to, input their data. Around, horse cases, coming in for colic, including, their preoperative, parameters findings at surgery, and, post-operative data. And, on the, screen there, just, some, screenshots that I've taken, just giving you an idea of the the type of data that we were collecting.
And on the right here, clinics were able to, generate their own, audit, these sort of, KPIS key performance indicators. So that they could see, you know, numbers of colic. How they were managed.
What their anaesthetic and surgery duration was and, key. Morbidities and mortalities. OK, so what did What results did we get?
So we contacted, all clinics that, offered, colic surgery across the world. And we identified, 226 clinics in 40 countries. And the graphs, here at the top show.
That, you know, most of these were based in, Europe, and North America, with representation from, other parts of the world. You might see in some of this, some of the presentation that we grouped, South America and Africa together and called them, rest of the world, just in case. I don't explain that in those slides.
So we contacted, all these, clinics. And we were really pleased with, an overall, response rate, of, just over a quarter of, all clinics, who, were willing to, participate. And you can see that, these are pretty representative of all of those, areas of the world.
As shown here. So how many, colic cases did these clinics see? And some of the data I'm going to present in some of the slides you'll see this term.
I QR That's the inter quartile range and in, sort of benchmark setting and, looking at data, we often don't look at complete, sort of minimum. And maximum, we look at that sort of, lower 25% and then the higher, 75% just to give a, a range, a representative spread rather than looking at the extremes, if that makes sense. So colic admissions for a clinic could range anywhere from 14 to 600 cases in a year.
This was, in, 2019. With most clinics being around about 100 and 50. So that inter quartile range was anywhere from 66 to 245 clinics had, on average, three, colic surgeons in their clinic.
The inter cortal range was 2 to 4, but obviously, this could range from one up to, 12 in in some clinics. And obviously not all colic cases were going to end up needing surgery. And for these, clinics, they performed around 44 colic surgeries per year.
Again, this varied, widely, and the inter quartile range was anywhere from 21 to 79 colic surgeries per year. So you know what investigations are clinics doing When, you know, horses are admitted, with colic. And I suppose this gives, horse owners, an idea of you know, what would be, a sort of a minimum or, you know, a sort of a a minimum sort of range of tests that might be conducted or those that are, you know, less common.
And we'd also give, vets, a sort of a an idea. You know, around what different clinics do in the management of colic cases. And you can see, you know, across, those, clinics that, fairly simple assessments such as looking at the pat, cell volume and total protein performing a rectal examination, are obviously, very key.
And usually, performed, either always or in most cases, but interestingly, you know, looking at other, technologies that have been developed over the years, actually, tests such as abdominal, ultrasonography lactate, are really, commonly, utilised as well areas where you know, clinics may, be, less, consistent in terms of, What they do might be, for example, looking at, biochemistry and electrolytes. And obviously, there are some tests such as abdominal, radiography, which are going to be, pretty uncommon. But may, differ.
Depending on your geographic region and the types of colic that you might get particularly around sun colic and lists. So just looking at, protocols. And this is something that, quality improvement and clinical audit does.
It's not all about the actual, patients themselves. It might be, looking at, procedures that are done, within a clinic. But it was, interesting to see, you know, whether there were, protocols, for example around, the technique for doing, abdominal synthesis or the location, or, more commonly, where, protocols are used for forming, abdominal, ultrasounds, to assess the abdomen.
So I mentioned about economics and, cost of, colic surgery. And we thought it would be interesting to look and see. You know what sort of range of costs that, we're looking at across the world and obviously, covid And, you know, the economic implications of other things that have gone on as a result of covid and events after that have probably caused these costs to to go up.
But please give us a AAA sort of an idea of where these costs are, or at least have been, so that we can compare them. So as you can see, management of a large colon displacement, more sort of simple. sort of surgical management.
Again, you know, ranged. reasonably, across the clinics. And, you can see, down here a breakdown.
For the, particular geographic regions of the world. And as you can see, once we start to become a little bit more, involved in terms of, either what we need to do surgically or, you know, critical care of cases. small intestinal strangulation.
Where horses might develop post-operative reflux and need post-operative fluids. You know, the cost of those, you know, starts to and looking at where we have to perform a resection, those would be at the higher, you know, end of cases. And again, we converted all of these into pounds.
But in general, the costs were most expensive in North American clinics, followed by the european ones. So, looking at the number of cases that were actually entered onto the portal, we had just over 4000. colic surgery.
Cases where data was entered and the graphs here, you can see, the number of, cases that were submitted in in each year. And, as you can see it, it's, you know, reasonably biassed towards, European clinics. But if you remember from the clinics identified to offer colic surgery, certainly a higher proportion of, clinics were within Europe.
And again, this just gives you an idea of, the where these data have have come from, particularly if you're in, a particular geographic, area where you want to look at those benchmarks for that particular region. OK, so, you know, other sort of features, for these, colic cases, we know that, colic can be quite seasonal. Overall, there wasn't a sort of a a massive seasonality, scene, and overall, you know, cases were sort, relatively, consistent.
We always look for a potential sort of, spring and Autumn Peak. Obviously, that's going to be different compared to, you know, northern or Southern Hemisphere. But you can see, you know, there might be a sort of a a bias pattern there, but, you know, generally it's, it's relatively consistent.
But as might not be a surprise to you, whilst, most, cases were admitted during working hours. About a third of, colic cases were admitted, between hours of eight o'clock at night and eight o'clock in the morning. So you know, that's that's important from AAA clinic perspective, you know, in terms of, staffing so that they're able to provide, care at those, times of night.
And, you know, just supports the fact that, you know, out of hours, provision of care is really important for, clinics that offer colic surgery. And what about the features of, horses that contributed to, this audit? And again, it gives us a a little bit of an idea.
Well, it helps us to sort of just check that these features don't, differ markedly. Between, you know, the different regions. But also, you know, some populations might be a little bit different, so you can see broadly.
You know, looking at age, you know, most cases are in the sort of the the region of the sort of the seven to, you know, sort of 13 year old, but it differs a little bit. So, you can see here the, the sort of the range of, ages here, with some the, extremes. And you can see, in general, for example, the North American cases were maybe slightly older than some of the others.
So slightly more geriatric horses, being presented for colic surgery, whereas, for example, clinics in Asia where there might be a greater proportion of, horses used for, racing, for example, might be why some of them are a little bit younger, but certainly, they did have a range of, age, ages as well and again weight wise again. No surprises here, but, whenever you're looking at data, you always want to look at the spread, and it again gives us, an idea. You know that 500 kg, if you're looking at an average, horse, you know is a good one to base any, sort of, protocols around, for example, around drug dosages.
In terms of the proportion of males and females. Well, again, Sort of a a fairly, even split here, as you might expect, but what does differ? Quite markedly, between regions are breeds, and, you know, this is important.
And why, you do have to sort of break down, data to to look at, particular aspects of this, and, breed would be one of those areas that might have an impact. On outcome. You know, a thoroughbred may be very different to a pony, for example, but as you can see, here, it's interesting to see that, variation in, the types of of the breeds of horses that were being presented at clinics for colic surgery.
So, in terms of key outcomes, you know, what does a vet, and an owner, want to want to know? Well, I guess, of those horses that go to a clinic for surgery, you know, at what stage, might we expect these horses to, either die or, being euthanased? And you can see here that, you know, there are a substantial, you know, number That might be, euthanased.
Or they might die, you know, and never get to the point of going to colic surgery. They might, die or be euthanased during surgery. Or, during, the recovery period.
But certainly, there would be a reasonable, proportion of cases that also, don't make it post-operative, postoperatively, to, clinic discharge. So this just gives you an idea for these, just over 4000. Surgical, colic.
Cases of, you know what proportions were, surviving to each of those phases. So if you're gonna give a ballpark figure to an owner, you know, around, you know, a horse going into a clinic for surgery, you know, what would you expect in terms of that horse making it, to hospital discharge. And our, results of these, data submitted to this would suggest, that around S, 60% of all horses.
Going for colic surgery would, survive to, discharge home. And it's, quite sort of reassuring to see that, you know that, proportion is, relatively, similar across, a different, global regions. Obviously, there might be, different reasons for, some of these individual, findings.
So what about horses? And, you know what happens, during surgery. And there's a relatively high proportion of horses that are, euthanased or die, during colic surgery.
As you can see again, it varies during, over geographic region. So the the proportion, was, lower in some parts of the world, than others. But again, it gives you a an overview.
Of what we'd expect this to be. And actually, when we, look at the data regarding the reasons for, horses, you know, not making it, into anaesthetic. Recovery, actually, the the greatest, proportion.
Of these cases were euthanasia for, welfare rather than, economic, reasons only, some of these cases might be a mixture of economic and welfare reasons. But would show that there's, you know, a substantial amount of cases where, you know, they are despite you know what we can do. You know, it was highly unlikely that those horses would, survive postoperatively.
And what about anaesthetic recovery? We know that, anaesthesia for, colic Surgery has come on in leaps and bounds over the years. But again, it's good to, and from a clinic level to know You know what a sort of AAA.
Standard would be where you are, you know, aware that that is, you know, what to be is to be expected or whether, it's higher than you might expect, which would indicate you do need to take some interventions so you can see, you know, the anaesthetic mortality. Did, differ, between, region. But overall, it was relatively low about, 6.2% of horses, either died or were euthanased during anaesthetic recovery.
And for those horses that actually, stood following surgery, which is, another, sort of key. Outcome measure. We know that around about 78% of those horses survived to hospital discharge, and again, there was a little bit of variation, in that, between, re regions.
But it's a useful, a figure to be able to, give to owners. And, this is obviously different from our previous, figure because, this excludes those cases that were euthanized, during surgery itself or which died. And as you can see from this, chart here, the reasons for, horses dying between, that period of anaesthetic recovery, and, hospital.
Discharge, was for a, a mixture of, reasons. Actually, relatively few died. Most of them were euthanized, due to, some form of welfare and, economic, reason.
So where where were these surgical lesions? And, you know, for AAA case that we think might have a more severe form of colic that, might need surgery. You know, where is the lesion most likely to be?
Well, possibly not a surprise. I mean, this is consistent with, you know, what is in the literature already, but gives this range for a much broader spread of clinics is that it's most likely to be, the large intestine, about 43% of cases or small intestine, 41% of cases. And and it's very unlikely to be either due to the small colon cum or other, regions of the G I tract and sort of wider abdomen, but it's a little bit different in terms of whether they're strangulating or not.
As you might expect, from your experience of, dealing with colic cases, you know, around three quarters of the large intestinal lesions were actually non strangulating, whether, whereas this was actually, the complete opposite of the small intestinal lesions where most of these are, you know, strangulating in nature. So coming on to our top 10, which of the surgical lesions, would be we would we be most, likely to encounter? And, I'm going to go through, each of these, lesions.
Obviously, we know that there's around about 88 different, surgical lesions. That horses might have, you know, for those that require surgical intervention, but these sort of top 10 are the ones that we're gonna focus on, and I'm going to provide you with some of the outcome data for those. So pedunculated lipoma were our, our number one.
They represented, just over 10% of, the, surgical cases in the incise, project. And you can see from this that, actually, a reasonable number of these were euthanized, or die during surgery. And I suspect that most of this, is, you know, with this being a disease of older horses and ponies might be a sort of an age related, aspect or might be, due to costs, due to the need to, perform a surgical resection as well.
If you look at, those, pedunculated lipoma cases that stood following anaesthetic recovery again, I think it's useful, as a bet, And, you know, to be able to convey that to a horse owner, around about 71% of those cases, survived, to hospital discharge. So next, down the list was right. Dorsal displacement.
And this was just under 10% of, surgical colic cases. And as you'll know, you know, a number of these, could be, managed. Medically, we we didn't, look at differences between, medical and, surgical management.
But for those cases that did need surgery. around. 80% of, those actually survived a hospital discharge, and this was slightly higher about 85 or 86% for those that stood following anaesthesia.
So, overall, you know, the prognosis, for for these type of lesions is generally very good. Whereas large colon Boulas, which is, obviously strangulating lesion again. Just under 10% of, the cases had this, again, a relatively high proportion of horses that, you know, died or euthanased, at surgery.
But for those cases, that did make it, through, surgery and which stood following anaesthesia. Around about 71% of those, survived a hospital discharge going back to our colon displacements. Our left dorsal displacement.
Nephrotic entrapments. There's about 6% of, the surgical colic cases. And as you would expect, you know, generally we expect these to have a good, prognosis for survival around about, 87% of all of those cases undergoing surgery and, you know, to hospital discharge, slight disparity.
You know, obviously there'll be some of those, that died or were euthanased either during surgery or anaesthetic recovery, but again, a really, really good, prognosis for those cases. About 88% of those horses that stood following anaesthesia, surviving to hospital discharge. EpiPen entrapments, gain another small intestinal strangulating lesion.
Again. A reasonable number of these cases actually euthanized or died, during surgery. But, for those cases that, did recover following, surgery and which stood you'd expect around, 68% of those cases to survive to hospital discharge.
So, you know, a reasonable rate of, mortality in that, hospitalisation, period. So, you know, as again we would expect from some of the published studies, you know, slightly more guarded prognosis in these cases. Primary large colon impactions.
Again, a number of these would be managed, medically, but for those, that did go to surgery again. The prognosis is really good, with around 75% of all cases surviving to hospital discharge, rising to about 82% of cases. And for those that stood the following general anaesthesia.
So, you know, we expect these, cases in general to do well, but obviously, you know, there are still a number that do have, complications following anaesthetic recovery, that, result in death or euthanasia in that post op period. Small intestinal barus again as another, strangulating lesion. A reasonable, you know, proportion of cases actually dying or being, euthanased during surgery and around, 70% of those, that stood following anaesthesia, actually surviving to hospital discharge, and then we've got those large colon sort of VVS that were not deemed to be strangulating.
They had a much better, prognosis, as you would expect. You know, compared to the strangulating forms of, large colon volvulus, with you know, you know, a relatively good prognosis for those about 88% of those cases, that stood following, anaesthesia surviving to hospital discharge. Sound impactions.
Gain. Not all of those would go to surgery. A number would be, medically managed.
But, as we know from, results, from, clinics that have, previously undertaken research in this area. They overall do have a, good prognosis for short term survival. And then I think earlier impaction was at number 10.
again, as we'd expect, a non strangulating, small intestinal lesion. These cases, do have a good, prognosis for, post-operative, cidal in that, early period. OK, so, you know, after surgery in terms of monitoring, again, you know, this is probably, of more use.
You know, to, clinics instead of looking at what they're doing. And that sort of benchmark setting, you know, to get an idea of what to expect. But in general, you know, Post op to monitoring is largely based around, total protein and pat cell volume.
You know, with, you know, almost around half of them, doing, lactase ultrasound. Slightly fewer doing, pain scoring, which is interesting. And again, that might be an area of focus.
And that's what clinical audit aims to do. We can do a repeat audit and see if you know awareness around, the, use of pain scores in monitoring post-operative colic patients has actually had any impact. And, for example, you can see that.
You know, around 60% of clinics would do, their post-operative checks every, 3 to 4 hours and this might be in, you know, useful information again for the clinics Looking at you know what they're doing compared to others and for horse owners to know what to expect in terms of protocols gain. What clinic? Clinical audit allows you to to look at, it was interesting to see.
You know what, clinics had, protocols. Either sat ones. That may or may not be followed.
different areas. And, you know, it was quite variable, and certainly is an area for future work. For example, protocols around.
antimicrobial use is very relevant if you're looking at the effects of, interventions and then finally coming on to some of these post-operative morbidities. And, you know, these are, sort of the overall, morbidities that we've seen, we can see that poster colic, was the most frequent of those, together with, post op reflux. Post-operative.
Ilias, just under 10% of, horses. Would have undergone repeat laparotomy and a reasonable number having post-operative diarrhoea with relatively few having, SARS or laminitis. And, as we would, expect and hope, you know, li deists of the linear alba being a really uncommon morbidity.
But we did sort of have a query around, some of the, results around, surgical site infection and and haemorrhage, because they seem to be a little bit different to what we were expecting. And we did have concerns around how well these are routinely, recorded, whereas the ones that I've just described, you know, are very easy to identify from clinic records. Some of these are the ones, less so.
So, again for a future audit, this might be an area to really focus on. And as I said, we've got, you know, some idea of, results from other studies. And it's interesting to see how these, compared and differed from, some of the, previously published, results.
OK, so that's a little bit of a, a fly through. You know what we found? You know, from the, preliminary assessment of this data.
And, final analysis of data is ongoing. As I, as, I give this, webinar. I'll be going back to this.
but we will be, submitting the the results of, this for publication. And, hopefully, you know, this information will be, useful for, you know, veterinary professionals, whether working in first opinion practise or in referral, level practise. But also importantly for, horse owners as well.
We know it's not just about, you know, those short term outcomes. What happens after horses go home from a clinic is really important. And we know that whilst, you can see from, these sort of classic, sort of curves survival curves for colic surgery.
We we know that the highest rate of post operative mortality is in that 1st 7 to 10 days following surgery, but that up to the 1st 30 days after colic surgery, that, you know, there still is a an elevated rate of post-operative, mortality. You know, and, sort of delayed post-operative complications such as, an incisional hernia. That takes, a number of weeks to become obvious.
This was a little bit limited. You know, as you'll be aware, you know, collecting data, you know, takes time. And, you know, that involves, finance as well.
So that was challenging, for for clinics to do, but hopefully, you know, with improvements in use of app technology, and being able to, get owners to contribute towards, data collection is really important, and hopefully will make this much easier. In the next, phase of, this, colic surgery audit, project, which actually will probably term a sort of a registry so that we can build, some research questions in there as well, but that's a topic for another talk. So, I hope you've enjoyed, this, webinar, key thing, you know, that I would hope that you would take home from us.
This is that you know that early identification of the surgical colic case is really important if we're going to get the best outcomes, but that, you know, by being able to give, owners, evidence based information. That can help. Some decision making, hopefully, the, in size project.
You know, is a a sort of a global, resource, that horse owners and, veterinary professionals can use, that's generated some, key outcome measures and as well as, you know, enabling, vets in the field and, owners to get some idea of what to expect. Clinics can also, see how they're doing and identify areas that and share areas of good practise, but also identify areas for improvement. So I'd just like to say a thank you for for listening to this, to my, project covets.
And in in particular, Tim, Ma, and Matthew Cullen, together with Joe ar, who's been doing, some of the data analysis and Stuart Southern, who developed the platform and a massive thank you to all those clinics that collaborated. on this project and, contributed, data to this project. Thank you very much.
