Welcome to this edition of the webinar Vet, entitled my entitled Complications Following Surgery. What do I do now? I am Matt Sinnovich.
I'm a surgeon and layman specialist at the Lipokean Hospital in Hampshire in the United Kingdom. So in this webinar, we will discuss how to approach complications. It's based around surgery, but the, the premises for this will be kind of relevant to other complications and sort of all complications from all sorts of procedures, and it's really the basic principles that, that we'll address here.
We'll get into some prevalence as well as, discuss a couple of case as we go through each, each, . Complication, I certainly don't have all the answers, but I will happily share with you some very current research, some experience, and we'll try and look at what's a huge topic. Here are the learning objectives outlined over there.
So, what is a complication, and what are we defining as a complication? So in preparation for this lecture on surgical complications, it became apparent that there's a lot of confusion which exists about the definition of what a surgical complication is. Is it, as one medical website put it, any undesirable result of surgery, in the European Journal of Surgery, they provide a more elaborate definition of every unwanted development in the illness of the patient or in the treatment of the patient's illness that occurs in the clinic.
While an esteemed historian of science suggests yet another definition in a recent volume on surgical complications where, A complication in any sphere of endeavour is something out of the norm and is the product of extraneous or unexpected factors. And because there's such a discrepancy in the definitions. This has led to one journal declaring that presently there's no clear or consistent definition of a complication in the surgical literature.
For this talk, I think then what will go is kind of include is a surgical complication is any undesirable and or unexpected result of an operation affecting the patient. This definition though limits complications to what generally happens in and around the clinic, but some complications, particularly in horses like incisional infections following colic surgery, may develop weeks or. Even a month post, post the operation, so I think we'll we'll include those as well in in the discussion here.
A spectrum of perioperative complications in horses undergoing procedures occur both under general anaesthesia as well as standing surgery, and a lot of these have been reported in various journals and in in various lectures, and it's definitely something that you'll have come across somewhere in your time, whether you've been involved in surgery or just looking at horses pre and post surgery. Those complications range from very transient mild conditions, to those that become life threatening, and there's many that haven't been reported or haven't even been thought up yet. As one of our, one of my surgery profess said to me, horses are only interested in two things, homicide and suicide, and they come up with very creative ways to, to make our lives and their own lives very difficult.
Some of these complications have to do directly with the anaesthesia or sedation, and some of them have to do directly with horse factors or factors of the surgery itself. We'll aim to discuss the most common perioperative complications reported in horses, as well as some of their associated risk factors here. I think that the awareness of such morbidities and the risk factors hopefully will aid in early recognition of these things, which means earlier treatment and hopefully more effective treatment, which hopefully again will result in improved outcomes.
For you and for your patient and for your client. Why are they important? So peropterative complications contribute to morbidity and mortality.
So we said there's, there's a wide range, and morbidity is anything that is untoward or unexpected. Mortality is, is obvious and leads leads to death. And there is a significant concern for horse owners, because of the emotional trauma and veterinary surgeons alike, but these can prolong recovery, they can increase cost, they can decrease the quality of life for your patient, and they can negatively impact long term survival.
So there are important things to think about and important things to discuss and important things to have a chat with your clients about, which is a beautiful segue and brings us on to informed consent. Now Informed consent is in all medical procedures, is something that needs to be obtained both medico legally, as well as from a relationship point of view with your clients and your patient. There is probably a strong argument that untrained laypeople cannot necessarily understand the risks, so true informed consent can never actually be obtained.
I think that our job as veterinarians and as diagnosticians and clinicians and surgeons is to explain things as simply as we can, taking into account the owner's risk profile and give them all of the alternatives and especially warn them what may happen. My typical speech may go something like, Talking about the risks of general anaesthesia is to give them, you know, say all anaesthesia in horses comes with some risk that, in healthy normal horses, that risk is probably minimal and give them a, a statistic. So the CPEF, stats at the moment are, depending on where your clinic is and what procedure is, you're probably looking at less than 0.5% to 1%, of cases have some sort.
Of issue. Most of those issues are in and around the recovery from anaesthesia. But these are risks that we do everything we can to mitigate.
But actually, whatever we do, the, the risk is there. You don't need to necessarily, with the clients go to in-depth listing of every single possible thing, because all that does is confuse them and, They tend to latch onto the most catastrophic thing and go, oh my God, that's terrible. So I think it's our job here to guide them a little bit.
Definitely not lead them, but guide them and say, look, there are risks there, be frank about the risks that are there and go, these are the risks associated with the surgery, the general anaesthesia, risk of, for example, trauma to associated structures, haemorrhage, infection, and just warn them about those sorts of processes. I think giving them a heads up is very useful. I've had many times where.
I've had a complication, and the owner's phone to report this to an owner, and they've got, oh yeah, you warned me about that, so that, that's OK. What do we do about it now? That already gets them on site.
So, building a little bit of that discussion into your informed consent, I think, will get the, the owners on your side and essentially everyone will buy into the process of, of getting that complication sorted. So, in order to provide some structure on what is a huge topic, I'll try and go through the body systems and give some prevalence of the potential complications. Show some case examples as we go, and then sort of just discuss how these were managed.
This list is by no means exhaustive, . But hopefully it does give a good oversight and gives us a bit of a a structure for some discussion. So gastrointestinal complications are by far the most commonly reported type of perioperative morbidity in the horse.
Gastrointestinal related complications reported in the horse after surgery, which does not involve the gastrointestinal tract, so that's elective surgeries, orthopaedic surgeries, respiratory surgeries, etc. Are general colic, diarrhoea, that may be from the procedure itself or antibiotic associated, and delayed faecal output. Again, that is one risk factor of being in a hospital for orthopaedic pain or orthopaedic procedures is delayed faecal output.
Gastrointestinal complications are reported after abdominal or colic surgery as well, and those can include postoperative ileus or post-operative reflux, depending on the ref the definition that you're talking about causes. If you're being very pedantic, all horses that have colic surgery will have post-operative ileus, for a transient period, no matter what you do, and that is just due to the physical handling of the intestine. But the clinical issue is the ileus or the reflux that we see, then bleeding, so hema peritoneum and peritonitis, as a secondary infection if there's been contamination or something else in the abdomen during surgery.
Post-anesthetic colic is the most commonly reported complication that's reported in horses undergoing elective surgery, as well as those recovering from colic surgery. And some incidences of those range from 0.2% to 1.4%.
However, in studies where all types of elective surgery were included in the analysis, the rates of postoperative colic, anaesthetic colic were generally higher, and these ranged from about 5.2% up to 18.5%.
Certainly, the methods used in different studies to diagnose colic may vary, and that's why we get this, this wide range that's there. It might be expected that the range of post anaesthetic colic is higher in horses recovering from colic surgery, and two studies reported relatively low rates of post anaesthetic colic, after surgery, varying between 7 to 8 and 8.1%.
However, horses that undergo specific types of colic surgery, such as small intestinal resection. There's a much higher rate, and that can be up to sort of 60% in in some horses, and that was that sort of postoperative ileus that we were talking about as well as the reflux. And similarly, horses recovering from, for example, a geoginostomy, it's been reported that a postoperative or post anaesthetic colic rate can be as high as 56%.
One study that specifically investigated risk factors for complications after colic surgery reported that the risk of suffering colic postoperatively was significantly and strongly associated with large colon torsion, and that was more than 360 degrees, as well as relaparotomy. So repeat surgeries mean that you're probably more likely to have a postoperative colic. Moving on to diarrhoea or diarrhoea or colitis has been reported to occur in the postoperative period in both horses undergoing non-abdominal surgery, as well as colic surgery.
And it might be anticipated that horses undergoing abdominal related surgery may experience a higher rate of post-op diarrhoea. And this is reflected in the findings in the literature with a reported incidence of diarrhoea in horses after non-abdominal surgery, somewhere between 0.6 and 2.8.
With a much higher postoperative diarrhoea in those that underwent colon surgery of nearly 70%. So other studies involving horses undergoing all types of colic surgery, so just that small intestinal and large intestinal, had a prevalence of somewhere between 2.2% and 30% of horses.
There was a study which specifically investigated risk factors for the development of colitis in horses after colic surgery and reported that pelvic flexture enterotomies, postoperative leukopenia or leukocytosis, and increased plasma lactate were significant risk factors which were associated with developing colitis in the postoperative period. In that study, colitis was diagnosed postoperatively. If diarrhoea and one or more of the following criteria were present, which was fever, leukopenia or ultrasonic evidence of colon inflammation, and that was where the colon wall was measured at more than 4 mils, and that was the study in 2023.
These conclusions could be drawn from the results of the study suggest that colitis as a postoperative complication does not necessarily negatively impact survival to discharge, but was associated again with longer hospitalisation and increased costs compared with those that didn't have postoperative colitis. So this is one of the important things to potentially discuss with horses or owners who thinking about having colic surgery, is that, depending on the type of lesion found, you may have some postoperative issues. Usually, that will be discussed at the time of surgery, but certainly it's something that you, you know, knowing your client's risk profile prior to going into that is, is definitely something to, to have in that pre-op discussion.
Reduced faecal output, may be anticipated postoperatively considering the depressive effects of general anaesthesia as well as sedation on, the gastrointestinal tract and its motility. There's a report of 43.5% of horses undergoing elective surgery that experienced reduced faecal output postoperatively.
Personally, I think that's quite high. And I think in contrast, there was another study that found horses undergoing elective orthopaedic or ophthalmic surgery, sorry, the number of postoperative defecations was not significantly different from physiological values. I think what happens sometimes in those studies is that we are.
Monitoring the horses for passing, and sometimes there is a little bit of a delay in passing, so while it's not necessarily reduced faecal output for an extended period, it's perhaps delayed faecal output, and I think it's an important, distinction between those. In that same study, which had the lower ones, gastrointestinal sounds were significantly decreased after general anaesthesia compared to the baseline. But the expected effect on faecal output was not seen in that.
So, when risk factors were examined, horses 5 years or older, they underwent orthopaedic procedures were more than of more than 60 minutes duration that did not receive phenylbutasone after surgery. They were at significant risk for developing reduced faecal output postoperatively. And I think that fits in with previous studies looking at orthopaedic procedures and risks for things like pelvic flecture inactions, as well as fecalactions where orthopaedic horses who'd have been on some foetal busone were potentially at a higher risk for both impactions and, seal impactions.
And that's another thing to think of in, in general clinical practise. Horses that have, you know, come off grass because they have a foot abscess or something like that and are now stabled. Obviously there is a risk of them developing reduced faecal outputs and impactions, both pelvic and faecal, and that's something just to warn clients about and have in the back of your mind if you are stabling a horse or changing management and there is some associated orthopaedic pain, they are at risk for a reduced faecal output.
Post-operative ileus or postoperative reflux after colic surgery has been frequently reported. There's a very wide range that's been reported in the literature. In horses after large colon surgery, one study reported that 3.3% of horses experienced postoperative ileus.
Which contrasts another study where 53% of horses had postoperative ileus and but that was specifically after ginal surgery. So, the precise nature of the colic surgery and the location of the surgical lesion is very likely to affect the rate of ileus or reflux suffered postoperatively. Investigation of risk factors found that, a PCV and the presence of a strangulating Pedanculated lipoma was significantly associated with postoperative ileus after colic surgery, and that was a high PCV I think that was above 40 or 45%.
Post-operative peritonitis after colic surgery is reported with a very low rate, ranging less than 1% in in most studies, but in some others as high as 18.5%. In the highest study, the majority of horses required a small intestinal resection.
I think that was above more than 72% of the horses in that paper. Which might in part explain the higher rate of postoperative peritonitis, given the likelihood for increased intestinal permeability in the lesions requiring resection. So that's pre-op as well as intra-op, as well as much sicker horses in general.
So that may also be an increased risk factor for the peritonitis. Peritonitis generally we would manage, medically, hopefully with some culture for appropriate antibiotics, but generally you would start with broad spectrum antimicrobials, probably including metronidazole, and then hopefully be able to get a sample. As you can see, the, abdominal centesis sample over there is a very turbid sample.
The sample being taken in the left image is via a teat cannula and that definitely is a procedure I would favour. If you're going to take a, a, a peritoneal tap and use the use of ultrasound to ensure a good sample and be a safe stick, I think is, is definitely warranted. Cathheter associated problems, including jugular thrombosis and thrombophlebitis are less frequently reported in horses after non-abdominal surgery compared to colic surgery, and that may be due to shorter duration of catheters, less fluid therapy, less drugs and things going through it.
After non-abdominal surgery under general anaesthesia, jugular thrombosis develops in sort of less than 1%, up to 2% of horses, which is in contrast to thrombosis rates of 5.8 to 8.4% in horses after colic surgery.
Now those tend to be much sicker horses, and horses that have, you know, endotoxin circulation and those sorts of things. Different types of catheter material may affect thrombosis risk, but it's likely that the complication is multifactorial. When polytetrafluoroethylene catheters are compared to polyurethane catheters in horses undergoing colic surgery, the rate of thrombosis was not different.
However, this study did find that the time that the catheter was present, was significantly longer in horses that developed thrombophlebitis compared to those that did not. Furthermore, they concluded that the state of debilitation, so how sick they were, is an important risk factor for the occurrence of thrombophlebitis. And these are supported by another study where PCV had an approximately linear relationship with the risk of developing jugular thrombosis after colic surgery.
So, the the higher the PCV the more compromised the patient was, the more likely they were to develop some sort of catheter associated problem. They also found an association of jugular thrombosis and heart rate at admission, with more than 60 beats per minute. While these factors might be difficult to avoid or control, awareness of these factors and is encouraged, and sort of vigilant in risk patients.
Certainly we, as a hospital are known to scan catheters at set times through . The hospital stays. This here you can see there's a catheter in a vein which has a tiny little thrombus on it centrally on that video, and we're quite proactive about Implementing treatment, whether that's topical therapies or systemic therapies to try and and get on top of those and use ultrasound again to monitor those very, very frequently.
Cathe associated air embolism has been very infrequently reported after surgery. One case report describes a horse that experienced postoperative air embolism of the brain after a jugular catheter accidentally became disconnected from the extension set. A horse suffered neurological sequela and was ultimately euthanized.
There are other reports of the sequela being very transient, and I think that depends on the dose of air which is embolized. . If they are developing seizure activity and and neurological signs, postmortem usually will show generalised cerebral edoema, gross malasia, and some haemorrhage.
And that's usually consistent with their MBI. Fever or pyrexia can occur postoperatively in horses from a range of surgical procedures, both under general anaesthesia as well as standing surgery. Typically, the classic one is laparoscopy, in which case we would always expect some type of pyrexia somewhere between 42 and 48, 72 hours.
That's something we'll always warn owners about. That is probably a sterile peritonitis and associated with, carbon dioxide used to inflate the abdomen. So that's one of those things that's definitely a known risk factor and a known complication.
And just warning the owners about that upfront and warning staff in the hospital about that upfront is usually very, very useful. After arthroscopy, rates of 0.37 to 5.1% have been reported in horses with pyrexia, and that's in contrast to soft tissue operations like post castration, which occur in more than up to 20% of horses.
Rates of post-operative fever can be as high as 79 to 85% after colic surgery, and certainly these were definitely reported in the early times of colic surgery. The nature of the surgery and any pre-existing systemic compromise might be likely to affect the rate of postoperative yorexia. One study specifically examined the relationship between postoperative fever and postoperative infection after colic surgery and found that peak temperature more than 39.2%, the timing of the peak temperature after surgery and the duration of pyrexia significantly affected infection rates.
That was a study by Freeman at all in 2012, and this distinguished between different grades of pyrexia which allowed further analysis of the significance of the pyrexia or the grade of severity. Generally, most horses post-sur will be on some sort of anti-inflammatory, systemically, and that mostly will be used to monitor, monitor as well as manage the fever or the pyrexia. Post-operative complications affecting the respiratory system are reported by several authors, although the particular classification varies between studies.
Pneumonia after colic surgery was reported to affect 0.9 to 3.6% of horses in two studies.
Another study found that horses experienced pneumonia after colic surgery were more likely to suffer post-operative fever and perioperative reflux compared to match controls. There's a bit of question as to whether the perioterative reflux, led to some cough or aspiration pneumonia, and that may be why they had that sort of rate. Cough.
Pneumonia and nasal discharge were experienced by 1.3% of healthy horses undergoing arthroscopy after general anaesthesia in one retrospective study, which is a little higher than the results of another retrospective study in horses, where there was only 0.68% which experienced respiratory complications, including pneumonia or mild respiratory infection.
Pulmonary edoema is a very uncommon but potentially life threatening condition in horses. In a study using match controls, gastric reflux and fresh frozen plasma administered during general anaesthesia were associated with postoperative pulmonary edoema. So that's something just to think about if that is something that's needed in theatre.
Tracheal injury so this is taken from the paper, just to show you kind of what that looks like endoscopically, the picture on the left, and the sequela of that is the picture on the right, which is, subcutaneous emphysema. So that's something which is an uncommon injury, with only a handful of reported cases. 4 horses experienced sloughing of the tracheal mucosa postoperatively in one retrospective study of about 1,0067 horses.
Tracheal trauma and secondary pneumonia occurred in two horses, thought to result from the movement of the ET tube, during neck manipulation for a myelogram. And tracheal rupture has occurred in another horse after endotracheal tube was removed with a cuff inadvertently left partially inflated in, recovery. These sorts of things are treated symptomatically, so anti-inflammatories, broad spectrum antimicrobials, and close monitoring of horses with emphysema.
They usually are self-limiting and do resolve. But again, one of those things that you try to avoid happening and care with your tube and placing of your tube and removing of your, of your ET tube during, anaesthetic procedures is paramount. Post-operative complications affecting the musculoskeletal system might include varying.
OK. Grades of lamus, myopathy, neuropathy, myomalacia, and laminitis. Lamus persisting into the postoperative period after elective arthroscopy, occurred in up to 11% of horses in one study, while another reported much lower percentages, that was sort of 0.74%, after endoscopy.
However, the degree of lameness might not be comparable between studies, which makes it difficult to draw conclusions about sort of the prevalence of that. But certainly we do know that there is the risk of lameness. After surgery, and that can be from a pre-existing lameness.
So the horse over here in this picture had a failure of its suspensory apparatus, as you can see in the shown by the picture from the, the dropping of the fetlock when it stood. It also had a very upright hock confirmation. So this would be a horse that is not a very good candidate for a fasciatomy neurectomy.
. It did not undergo a fasciotomy neurectomy but did have a persistent lameness, and this is the sort of horse that if it did go through that procedure may have recurrence of the disease or persistent lameness post. Myopathy and neuropathy might be difficult to distinguish or might coexist in some affected cases. Myopathy after colic surgery has been reported to affect between 0.4%, up to sort of 3.7% or 3.8% of horses, and that's through a number of studies.
Another study found a similar rate of postoperative myopathy or neuropathy in horses after elective surgery, reporting a rate of 0.8%. The aetiology of postoperative myopathy and neuropathy has been extensively investigated and when considering the risk factors for development of myopathy or neuropathy, one study hypothesised that horses undergoing anaesthesia for MRI would experience a higher frequency of postoperative myopy neuropathy compared to those undergoing.
Anaesthesia for surgery, and that was thought to be due to the, increased time required for the MRI at the time that they were compressed. However, no association was found in that. But the study did show that overall horses that experienced postoperative myopathy or neuropathy were significantly heavier than those that did not.
And in total in this, in that study, 1.7% of horses experienced clinical signs consistent with myopathy in the post-op period. In earlier studies, hypertension and poor positioning, prolonged anaesthesia times were definitely identified as risk factors for post-operative myopathy or neuropathy, and we definitely find that in the heavier horses.
This horse here, as you can see, has struggling to protect him forward. This had a long procedure and developed a myopathy which was self-limiting. It was treated with some anti-inflammatories and did just fine.
Laminitis in the postoperative period has been reported by several studies after colic surgery at a rate that ranges from 0.4 to 12%. Risk factors for the development of laminitis after colic surgery were examined by a study, and the only factor that was significantly increased was significantly increased the risk of laminitis was the absence of the absence of low molecular weight.
Heparin therapy. However, horses that are at risk for laminitis, so your EMS horses may be at an increased risk of laminitis in general due to the cortisol, etc. .
And maybe at risk post colic surgery. The study was the previous study was retrospective and not randomised, the comparisons made between horses receiving or not receiving low molecular weight heparin might have hindered the, the different time frames. They are important to encourage the prospective evaluation, however, and further investigation of preventative therapies in, in, in such horses.
After orthopaedic surgery, in a very large study of 3500 horses, only 23% experienced postoperative laminitis. However, supporting lamini laminitis has been reported to occur after some surgical procedures, and that necessitates prompt diagnosis and appropriate management. And as you can see, there's a picture over there.
I'll show you of a horse that underwent surgery. That was the foot of the horse. It ended up having a solar penetration that unfortunately is not the the correct radiograph which shows you what it would have looked like.
And this was the horse in, had a protracted recovery following a fracture of the hind end with a fetlock arthrodesis. Fortunately, it was a good horse that managed to, lie down and took the weight off. As you can see the pads on the front feet there, so it was managed conservatively, and fortunately we did manage to get that horse back and it went on to have a long, happy breeding career.
Neurological signs. So, this here is a horse that has neuropathy, as you can see radial nerve. So that classic drops shoulder and inability to straighten the forum.
Cerebral necrosis has been infrequently reported in the literature. One small case series of 5 horses that experienced signs of postoperative cerebral necrosis developed clinical signs between 5 hours and 7 days after the GA. The authors in that paper discussed the periods of intraoperative hypercapnia and hypoxemia may have been significant, and that's 4 of the 5 effects of horses underwent colic surgery and dorsal recumbency.
In contrast, another case report described post-anesthetic cerebral necrosis in healthy pony undergoing an elective castration. In this particular case, abnormal neurological signs were seen shortly after the end of anaesthesia. The low number of reported cases makes it difficult to, extrapolate risk factors for that.
Spinal cord myelome, sorry, myelomalacia or myelopathy, again, is very uncommonly reported. A recent review explored the potential aetiology, but to date the precise mechanism is unclear. And one case report described the clinical signs of post-anesthetic myelopathy to include the inability to stand, flaccid paresis of the hind limbs, absence of reaction to an induced pain stimulus of the hind limbs, with no patella or anal reflex present, weak tail tone, and an absentinicular reflex distally from the 17th intercostal space.
The incidence of myelome is hard to estimate, given the very few number of cases, but something sort of risk factors may be young native cults and horses put in dorsal recumbency. So again, something just to think about and potentially if you see that type of, of case to maybe warn an owner prior to surgery. The horse with the radial nerve was given supportive therapy as well as dexamethasone, systemically and made a full recovery.
There she is in a splintered Robert Jones, which allowed her to wait there and made her much more comfortable. Corneal injury or abrasion. A prospective study involving 34 healthy horses undergoing GA for elective non-ocular surgery reported that 17.6% of horses developed some type of corneal abrasions.
That was in a centre using a rope recovery system, . And that identified the duration of anaesthesia, total length of recumbency and lateral recumbency as risk factors for corneal abrasion, or corneal trauma, . Those again are managed daily routinely, so you'd stay in the eye, manage the edoema with anti-inflammatories and a broad spectrum antimicrobials for the ulcer, regular treatment with an SPL or topical if the horse will tolerate it.
Moving on to surgical site infection, as you can see, that is a really, really horrible supparative infection going on on the hind quarter of, of the horse over there. It was a horse that went through a gate, and had a large deloving wound that was then sutured, developed that really, really horrible, surgical site infection, which was treated topically as well as systemically and ultimately with a lot of debridement. In this case, the horse did culture and MRSA, and the treatment that we used for that one was to use some hypertonic saline to flush it, as well as debridement.
And then, topical antimicrobials, as well as frequent debridement until we were on top of the infection. After elective arthroscopy, the incidence of incisional infection appears to be very, very low. Two studies reporting similar results of rates between 0.6 and 0.7%.
Reported rates of joint infection or sepsis after elective arthroscopy also seems to be very low, with rates ranging between 0.7 and 1.2%.
In contrast, incision infections or complications after common colic surgery are much more common, and complications encountered include edoema, infection, herniation, and dehiscant. The rate of incisional infection after colic surgery might be as high as 43%, depending on the studies that you read. Risk factors for abdominal incision site infection have been reviewed extensively everywhere, and those can be seen in papers by, Salem and Kelmer.
There are many techniques used to try and decrease those from the application of, honey in the wound, which may or may not help, topical antimicrobials, again, which may or may not help the type of suture material used, the number of, layers of closure used, the. Of a stent in recovery, the use of a dressing in recovery, the use of an iodine in recovery, changing that immediately out of recovery. All of those things are reported and unfortunately there is no strong consensus between them all.
What we do know is that mostly those do heal and . Appropriate antimicrobial therapy based on culture results is, is always good and and always useful. But the mainstay of treatment of those will be, as this, this wound over here shown would be lavage and debridement, and generalised wound care.
So by improving the awareness of these potential complications with early recognition and treatment, hopefully we can improve outcomes. And factors that are known to affect the risk of developing certain conditions should always be considered, and horse owners should be counselled early and actively when necessary. This is, there's no, science behind, one of these last slides, but this is the best advice I ever received, which was from a very, very eminent and very distinguished surgeon.
I had the privilege of working with as well as listening to him lecture at many congresses. And he said something very recently, and it took me a while to understand this. He said, I used to dread complications.
And I thought, yeah, I, I can get behind that. He said, I used to hate them. Again, I could get behind that.
He said, I was afraid to answer the phone from a client after this, after the horse had been discharged home, and that that's something I think many of us can relate to. He said, but I learned to to love complications, and now I think they're great. All of us in the room shook our heads in dismay, and we thought this is an impossible situation.
There's no way you can love complications. But he went on and he said, I've learned that all clients want from us is our best. If we can give them that and fixing their problems, not only will they be on our side, they will pay our bills willingly, and they'll come back for more.
And we ourselves will get better and better. And that is only good for us and our patients. So now I embrace complications.
I love them, I want them, because every time I actively approach them. I learn something new, and every time I get better. So hopefully you will have got some good advice through this talk and hopefully.
If you take nothing else home from this, you will take home at least the fact that. Early counselling and getting the client on side early is the way to do it. Owning the problem and being with the client in solving the problem, I think is the essence of what my esteemed colleague had been had been talking about.
And I think that a proactive approach to complications and a proactive approach to resolving them will get the client on side and will get a resolution for the client and your patient and for you. This is the preeminent text on complications in equine surgery. And for anyone who wants to read more or know more, I definitely direct you to this very well written book.
Again, far more extensive, than what's been covered in the lecture here. But if you do want any, any detail, that is very definitely a great reference. So in summary, I think approaching all surgery, you need a good team, you need the correct diagnosis, and the same thing applies to complications in and around surgery.
Having a good team and having the correct diagnosis of the complication means that you will get the correct therapy for the problem and have the ongoing correct management. Before surgery, warn the owners of what common problems may be, and that way they'll already be on your side if and when the complications do occur. Learn from them, embrace them and get better at handling them.
And with that I'll say thank you very much. I hope you enjoyed this talk.
