Evaluation of long-term postoperative morbidity and survival after equine colic surgery using a complication severity classification.
Authors: M. Gandini, G. Giusto
Journal: The Veterinary record
Summary
# Editorial Summary: Long-term outcomes after equine colic surgery Gandini and Giusto's retrospective analysis of 176 horses followed for ≥4 years post-colic surgery addresses a significant gap in the literature by characterising long-term morbidity alongside survival—a dimension largely overlooked in previous outcome studies that focus predominantly on discharge survival and immediate postoperative complications. Using the equine postoperative complication score (EPOCS), the researchers found that whilst long-term survival was generally favourable, post-discharge complications occurred in nearly 45% of cases, with recurrent colic being the most frequent problem; critically, pre-discharge EPOCS was negatively correlated with long-term survival (r = −0.25, p = 0.002), whereas complications occurring after discharge did not predict mortality. The counterintuitive finding that lesion type, intestinal segment and resection extent did not significantly influence long-term survival suggests that management of early postoperative complications may be more prognostically important than the initial surgical pathology. For equine practitioners, EPOCS offers a standardised framework for documenting and comparing complication burden across different surgical cases and management protocols, facilitating more meaningful audit of surgical outcomes beyond simple survival rates—though the single-centre design and owner-reported follow-up data warrant caution in generalising these findings to other populations and suggest that minor complications may be underrepresented in the dataset.
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Practical Takeaways
- •Expect nearly half of colic surgery patients to develop post-discharge complications, primarily recurrent colic; clients should be counselled accordingly and monitored long-term.
- •Use the EPOCS scoring system to quantify perioperative complication severity—horses with higher pre-discharge scores have significantly reduced long-term survival and warrant closer management.
- •Focus perioperative management on minimizing complications during hospitalization, as these have stronger prognostic value than post-discharge events for long-term outcomes.
Key Findings
- •Post-discharge complications occurred in 44.8% of horses, with recurrent colic being the most common complication.
- •Pre-discharge EPOCS was negatively correlated with long-term survival (r = -0.25, p = 0.002), indicating higher complication severity scores predict worse outcomes.
- •Total EPOCS was inversely associated with survival (r = -0.19, p = 0.02), while post-discharge EPOCS alone was not significantly associated with survival.
- •Long-term survival was favourable overall, with 176 of 203 discharged horses successfully followed up at ≥4 years post-surgery.