Factors associated with development of post-operative reflux in horses with large colon volvulus and association with complications and outcomes.
Authors: Watrobska Natalia, Gough Rachel, Hallowell Gayle, Haugaard Simon, McGovern Kate F
Journal: Equine veterinary journal
Summary
# Editorial Summary: Post-operative Reflux Following Large Colon Volvulus Surgery Although post-operative reflux (POR) rarely develops after large colon volvulus (LCV) repair in the absence of small intestinal damage, its occurrence and prognostic significance have been poorly characterised until now. This retrospective analysis of 128 horses undergoing LCV surgery at a UK referral centre between 2008 and 2021 identified POR (defined as ≥2 litres of gastric reflux on at least one post-operative occasion) in 18% of cases, with strikingly different outcomes compared to non-refluxing horses: whilst 95% of horses without POR survived to hospital discharge, only 44% of those developing POR achieved this milestone, representing a 26-fold increased risk of mortality. The survival disparity persisted at three-year follow-up, with post-operative refluxors showing a 13.4-fold greater likelihood of being deceased. Although the retrospective design limited complete data capture across all variables, these findings establish POR as a powerful negative prognostic indicator independent of the primary LCV diagnosis, warranting heightened clinical vigilance for early reflux detection and aggressive medical management in the post-operative period to optimise patient outcomes.
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Practical Takeaways
- •Post-operative reflux in large colon volvulus cases is an important complication to monitor for, as its presence carries a grave prognosis with only 44% surviving to discharge
- •Horses developing reflux after LCV surgery require aggressive management and owners should be counselled on significantly reduced survival odds compared to non-reflux cases
- •Early detection and treatment protocols for post-operative reflux in LCV cases are critical, as this complication marks a major shift in prognostic outlook
Key Findings
- •Post-operative reflux occurred in 18% (23/128) of horses following large colon volvulus surgery despite absence of small intestinal lesions
- •Horses with post-operative reflux had 26-fold higher odds of non-survival to hospital discharge (44% vs 95% survival; p<0.001)
- •Post-operative reflux horses had 13.4-fold higher odds of mortality within 3 years post-surgery (p<0.001)
- •Overall survival rate to hospital discharge was 86% in the LCV cohort, with post-operative reflux identified as a strong negative prognostic indicator