Analysis of sodium carboxymethylcellulose administration and related factors associated with postoperative colic and survival in horses with small intestinal disease.
Authors: Fogle Callie A, Gerard Mathew P, Elce Yvonne A, Little Dianne, Morton Alison J, Correa Maria T, Blikslager Anthony T
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Sodium Carboxymethylcellulose and Post-operative Outcomes in Equine Small Intestinal Surgery Adhesion formation represents a significant challenge following equine abdominal surgery, frequently resulting in recurrent colic and poor long-term survival. This retrospective analysis examined 203 horses undergoing small intestinal surgery, comparing 33 animals that received intraoperative sodium carboxymethylcellulose (a viscous lubricant designed to inhibit adhesion development) against 170 historical controls, with survival tracked over 180 days using Kaplan-Meier survival analysis. Remarkably, 75% of treated horses survived to day 180, whilst untreated animals had a median survival of just 8 days—horses without CBMC were twice as likely to die, with postoperative ileus and recurrent colic further elevating mortality risk by 1.4- and 1.3-fold respectively. For equine practitioners, these findings suggest that intraoperative CBMC administration merits serious consideration as a prophylactic strategy in small intestinal cases, particularly when postoperative complications appear likely, though the retrospective design and historical comparison group warrant cautious interpretation of the magnitude of benefit. The apparent protective mechanism—reducing early adhesion formation and its cascading complications—aligns well with the known pathophysiology of postoperative colic, making this an accessible intervention worthy of discussion between surgeon and owner when planning high-risk cases.
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Practical Takeaways
- •Intraoperative CBMC administration substantially improves long-term survival in horses undergoing small intestine surgery, with median survival extending from 18 days to at least 180 days
- •Consider CBMC use as standard protocol in colic surgery to reduce adhesion formation and associated postoperative complications
- •Monitor closely for postoperative ileus and colic signs, as these are strong independent predictors of poor outcome
Key Findings
- •75% of horses administered intraoperative CBMC survived to 180 days compared to 75% of untreated horses surviving only 8 days (median survival 18 days)
- •Horses not receiving CBMC were twice as likely to die as those receiving CBMC
- •Postoperative ileus increased mortality risk by 1.4-fold and postoperative colic signs by 1.3-fold