Clinical findings associated with development of postoperative reflux and short-term survival after small intestinal surgery in geriatric and mature nongeriatric horses.
Authors: Boorman Sophie, Stefanovski Darko, Southwood Louise L
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Postoperative reflux remains a significant complication following small intestinal surgery in horses, yet its development appears driven by perioperative factors rather than age alone. Boorman and colleagues conducted a retrospective analysis of 83 horses (44 geriatric, ≥16 years; 39 mature, <16 years) undergoing small intestinal surgery between 2009–2015, examining clinical variables associated with postoperative reflux (>2 L at first intubation), high-volume reflux (≥20 L in 24 hours), and short-term survival using multivariable logistic regression. Elevated packed cell volume and pre-existing nasogastric reflux at admission predicted postoperative reflux development, whilst high-volume reflux was additionally associated with hyperglycaemia and small intestinal resection; critically, prolonged surgical time and high-volume reflux were the only significant predictors of nonsurvival. Age—whether analysed continuously or categorically—held no statistically significant association with reflux occurrence or mortality, a finding that carries substantial clinical weight for surgical decision-making. These results suggest that pre-admission dehydration status, glucose metabolism, and intraoperative technical factors warrant greater prognostic consideration than chronological age, potentially supporting surgical intervention in suitable geriatric candidates previously deemed higher risk on age grounds alone.
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Practical Takeaways
- •Age alone should not be a barrier to recommending colic surgery in horses ≥16 years; outcomes depend on pre-operative clinical status rather than age
- •Pre-operative nasogastric reflux is a critical warning sign for post-operative complications; horses presenting with reflux require careful patient selection and intensive post-operative monitoring
- •Monitor for high-volume reflux post-operatively (≥20L in 24 hours) as it is a strong negative prognostic indicator; surgical time and reflux management are modifiable factors affecting survival
Key Findings
- •Age (geriatric ≥16 years vs mature <16 years) was not associated with postoperative reflux development or survival outcomes
- •Pre-operative nasogastric reflux at admission was the strongest predictor of postoperative reflux (OR 4.61) and high-volume reflux (OR 10.05)
- •High-volume postoperative reflux (≥20L/24h) and prolonged surgical time were independent risk factors for nonsurvival
- •Elevated packed cell volume and blood glucose at admission were associated with increased reflux risk in geriatric horses