Effects of age, disease and anastomosis on short- and long-term survival after surgical correction of small intestinal strangulating diseases in 89 horses.
Authors: Rudnick Meredith J, Denagamage Thomas N, Freeman David E
Journal: Equine veterinary journal
Summary
# Editorial Summary: Long-term Survival After Small Intestinal Strangulation Surgery Whilst short-term survival rates after colic surgery are well documented, little is known about outcomes across the typical lifespan of horses; this retrospective study of 89 horses tracked post-operative survival over periods of up to 13 years following surgical treatment of small intestinal strangulating diseases to identify which factors influence long-term prognosis. Using Kaplan-Meier survival analysis and multivariable Cox proportional hazards modelling, researchers examined how age at surgery, disease type and surgical technique (specifically the need for anastomosis or resection) affected median survival times. Horses aged 16 years and older showed substantially poorer long-term survival (median 72 months versus 122 months in younger horses), whilst those avoiding resection and anastomosis achieved longer survival times (120 months versus 77 months post-jejunocecostomy); in multivariable analysis, age emerged as the dominant prognostic factor (hazard ratio 2.67), though avoiding anastomosis also significantly improved outcomes. For practitioners, these findings emphasise that prognosis must be contextualised within each horse's remaining lifespan rather than simple post-operative survival, and underscore the critical importance of early surgical intervention—potentially within the first few hours—to preserve intestinal viability and avoid the need for resection. Whilst acknowledging limitations including relatively small cohort sizes and incomplete follow-up data, this study provides valuable long-term outcome data for pre-operative counselling and prognostic discussions with owners.
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Practical Takeaways
- •Early surgical intervention to avoid intestinal resection and anastomosis improves long-term survival outcomes; consider aggressive early treatment protocols
- •Age at surgery significantly impacts long-term prognosis; discuss realistic survival expectations with owners of older horses (≥16 years) requiring colic surgery
- •Horses that can be managed with simple correction without resection have substantially better long-term survival, supporting conservative surgical approaches when possible
Key Findings
- •Horses aged ≥16 years had significantly shorter median long-term survival (72 months) compared to younger horses (121.7 months), P=0.002
- •Horses without intestinal resection had significantly longer survival (120 months) than those requiring jejunocecostomy (76.8 months), P=0.02
- •Age (HR=2.67) and requirement for anastomosis (HR=0.65) were the most significant factors affecting long-term survival in multivariable analysis
- •Short-term post-operative survival was not affected by age, disease type, or surgical correction method