Factors associated with survival of horses following relaparotomy.
Authors: Findley J A, Salem S, Burgess R, Archer D C
Journal: Equine veterinary journal
Summary
# Relaparotomy in Horses with Colic: Survival Factors and Clinical Outcomes When colic surgery complications necessitate a second laparotomy, clinicians and owners face difficult prognostic decisions with limited data to guide expectations. Findley and colleagues reviewed 96 horses requiring relaparotomy within eight weeks of initial colic surgery (representing 6.3% of 1,531 laparotomies performed over a decade), using Cox regression modelling to identify factors predicting survival. Overall median survival was just six days, though horses recovering from anaesthesia survived a median of 778 days; survival varied markedly by complication type, ranging from 53% for persistent post-operative colic to 0% for septic peritonitis. Elevated packed cell volume 24 hours post-initial surgery, peritonitis as the relaparotomy indication, and adhesion formation were significantly associated with non-survival (hazard ratios 1.06–4.41), whilst colic signs as the relaparotomy reason and small intestinal distension were protective factors. These findings provide evidence-based prognostic indicators that can help practitioners counsel owners on realistic outcomes and determine whether relaparotomy is warranted, particularly highlighting that peritonitis carries substantially worse prognosis than uncomplicated post-operative colic recurrence.
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Practical Takeaways
- •When counselling owners about relaparotomy for post-operative complications, survival outcomes vary significantly by complication type (0-53%), with septic peritonitis carrying extremely poor prognosis and persistent colic being more favourable
- •Elevated packed cell volume and peritonitis at the time of considering relaparotomy are poor prognostic indicators; these findings should inform clinical decision-making about whether to proceed with surgery
- •Horses presenting with simple persistent colic signs for relaparotomy have considerably better survival prospects than those with peritonitis or adhesions, helping guide realistic outcome discussions with owners
Key Findings
- •Relaparotomy was performed in 96 horses (6.3% of 1,531 laparotomies) at a median of 4 days post-initial surgery, with overall median survival of 6 days and 778 days for those recovering from anaesthesia
- •Short-term survival rates varied by indication: persistent colic 53%, incisional dehiscence 50%, post-operative reflux 37%, haemoperitoneum 17%, and septic peritonitis 0%
- •Nonsurvival was significantly associated with elevated packed cell volume at 24h post-laparotomy (HR 1.06), peritonitis as relaparotomy indication (HR 4.41), and presence of adhesions (HR 1.77)
- •Improved survival likelihood was associated with colic signs as relaparotomy reason (HR 0.48) and small intestinal distension found at relaparotomy (HR 0.53)