Risk factors for equine postoperative ileus and effectiveness of prophylactic lidocaine.
Authors: Torfs S, Delesalle C, Dewulf J, Devisscher L, Deprez P
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Risk Factors and Prophylactic Lidocaine in Postoperative Ileus Postoperative ileus remains one of the most serious complications following small intestinal colic surgery, yet effective preventative strategies remain limited. Torfs and colleagues conducted a retrospective analysis of 126 horses that survived at least 24 hours post-surgery, examining 31 pre-, intra-, and postoperative variables to identify risk factors for ileus and evaluate whether prophylactic intravenous lidocaine could improve outcomes. Three key factors significantly predicted ileus development: elevated admission heart rate (each beat per minute increase raised odds by 5%), presence of greater than 8 litres of nasogastric reflux on admission (threefold increase in risk), and requirement for small intestinal resection (2.5-fold increase in risk). Notably, horses receiving prophylactic lidocaine showed a 75% reduction in ileus incidence and improved short-term survival rates, suggesting this relatively simple intervention warrants serious consideration as standard post-operative protocol. These findings offer practitioners a practical framework for risk stratification and support the use of intravenous lidocaine as an evidence-based prokinetic agent in the immediate post-operative period for high-risk cases.
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Practical Takeaways
- •Horses presenting with high heart rate, large-volume reflux (>8L), or requiring intestinal resection should be considered high-risk for postoperative ileus and managed accordingly with enhanced monitoring and prokinetic support
- •Prophylactic IV lidocaine administration during and after small intestinal colic surgery significantly reduces POI development and improves survival outcomes—consider as standard protocol for at-risk cases
- •These identifiable risk factors allow more accurate prognostication to horse owners and can guide treatment intensity in the immediate postoperative period
Key Findings
- •High heart rate at admission (OR=1.05) was significantly associated with increased POI risk
- •Reflux volume >8L at admission increased POI probability 3-fold (OR=3.02)
- •Small intestinal resection increased POI risk 2.46-fold compared to other surgical approaches
- •Prophylactic IV lidocaine reduced POI incidence by 75% (OR=0.25) and improved short-term survival (OR=0.30)