The Effects of Antimicrobial Protocols and Other Perioperative Factors on Postoperative Complications in Horses Undergoing Celiotomy: A Retrospective Analysis, 2008-2021.
Authors: Rockow Meagan, Griffenhagen Gregg, Landolt Gabriele, Hendrickson Dean, Pezzanite Lynn
Journal: Animals : an open access journal from MDPI
Summary
# Editorial Summary: Antimicrobial Protocols and Postoperative Complications Following Equine Celiotomy Between 2008 and 2021, researchers retrospectively analysed 742 celiotomy cases (608 completed surgeries, 134 terminated intraoperatively) at a tertiary equine hospital to determine whether specific antimicrobial regimens and perioperative management strategies reduced postoperative complications including incisional infection, ileus, and other adverse events. Contrary to expectations, the timing and type of antimicrobial prophylaxis—whether administered pre-, intra-, or postoperatively—showed no protective effect against incisional infection or postoperative ileus, suggesting that current broad-spectrum protocols may be difficult to differentiate in their efficacy or that individual patient factors override antimicrobial choice. Notable risk factors emerged for specific complications: prolonged NSAID administration increased incisional infection risk (1.14-fold per day of use), whilst postoperative lidocaine and alpha-2-agonist use were associated with substantially higher ileus rates (21.5-fold and 1.56-fold respectively), and poor anaesthetic recovery quality, multi-drug NSAID regimens, and addition of antimicrobials beyond penicillin–gentamicin combinations elevated risk of miscellaneous complications. These findings suggest that antimicrobial selection alone may not be the primary driver of postoperative infection in uncomplicated celiotomies, and that clinicians should critically evaluate the duration and breadth of NSAID protocols and judicious use of postoperative analgesic agents—areas potentially offering greater impact on outcome than further refinement of prophylactic antibiotic strategies.
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Practical Takeaways
- •Antimicrobial protocol selection (type and timing) may be less critical than previously thought for preventing infection after celiotomy—focus efforts on other modifiable factors
- •Limit NSAID duration and avoid multiple different NSAID classes postoperatively to reduce incisional infection and complication risk
- •Use caution with postoperative lidocaine and alpha-2-agonists as they are associated with increased ileus; consider alternatives for pain and sedation management
Key Findings
- •Antimicrobial type or timing were not associated with decreased risk of incisional infection or postoperative ileus in horses undergoing celiotomy
- •Duration of NSAID use was positively associated with incisional infection (OR 1.14 per day)
- •Postoperative lidocaine and alpha-2-agonist administration were associated with increased postoperative ileus incidence (OR 21.5 and 1.56 respectively)
- •Poor recovery quality, addition of antimicrobials beyond penicillin/gentamicin, and increased NSAID class variety were risk factors for other complications, while enterotomy implementation was protective (OR 0.64)