Development of a classification system for equine postoperative complications and its application in a cohort of 190 horses undergoing emergency laparotomy.
Authors: M. Gandini, G. Giusto
Journal: The Veterinary record
Summary
# Editorial Summary: Standardising Postoperative Complication Reporting in Emergency Equine Colic Surgery Gandini and Giusto have developed and validated the first standardised classification system for postoperative complications in equine emergency laparotomy, addressing a significant gap in how equine surgeons document and compare surgical outcomes. The authors retrospectively analysed 190 horses that recovered from anaesthesia following colic surgery, applying their newly proposed equine postoperative complication score (EPOCS) classification to categorise all reported complications pre-discharge, then correlating severity grades with hospitalisation costs and duration. Nearly three-quarters of horses experienced some form of postoperative complication, with the majority presenting manageable class 1–3 complications (60.4%), whilst 7.4% deteriorated to fatal outcomes; critically, the EPOCS classification and its severity grades demonstrated meaningful correlation with both hospital stay length and treatment costs, suggesting the system has genuine prognostic and economic value. This standardised approach matters significantly for equine practitioners because it moves beyond subjective, inconsistent complication reporting, enabling more reliable comparison of outcomes between surgeons, hospitals and techniques—essential data for refining protocols and counselling owners about realistic recovery trajectories. Whilst limited by its single-centre design and some arbitrary scoring definitions, the framework provides a practical foundation for larger, multi-centre validation studies that could ultimately establish it as a benchmark for quality improvement in equine emergency surgery.
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Practical Takeaways
- •Use standardized complication classification when documenting postoperative outcomes to enable meaningful comparison of surgical results and identify quality improvement opportunities across your practice.
- •Complication severity correlates with hospitalization duration and cost—horses with higher EPOCS scores require longer recovery periods and generate higher treatment costs, useful for client communication and case planning.
- •Implementing objective complication grading removes subjective interpretation and provides clarity on patient prognosis; nearly 75% of colic laparotomy patients either recover without complications or experience only mild-to-moderate issues, which is reassuring for owner counseling.
Key Findings
- •A new classification system for equine postoperative complications (EPOCS) was developed and successfully applied to 190 horses undergoing emergency laparotomy.
- •7.4% of horses (14/190) did not survive to discharge (class 6 complications), while 24.7% (47/190) had no postoperative complications.
- •Postoperative complication classification correlated significantly with both hospitalization cost and length of stay, enabling objective grading of surgical outcomes.
- •The majority of horses developed mild to moderate complications: class 1 (22.6%), class 2 (15.8%), or class 3 (22%) complications, with only 7.3% experiencing severe complications (class 4-5).