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Home / Equine Research Bank / Equine Vet J / A multi-centre cohort study investigating the outcome of syn...
Equine veterinary journal2019; 52(3); 404-410; doi: 10.1111/evj.13180

A multi-centre cohort study investigating the outcome of synovial contamination or sepsis of the calcaneal bursae in horses treated by endoscopic lavage and debridement.

Abstract: Previous studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited. Objective: To investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections. Methods: Retrospective analysis of clinical records. Methods: Medical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow-up questionnaire was used to determine survival and return to athletic performance. Descriptive statistics and Cox proportional hazards survival models were used to determine factors associated with survival. Results: Horses underwent one (n = 107), two (n = 19), or three (n = 2) surgeries. Survival to hospital discharge was 84.4%. Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (hazard ratio, [HR] 0.41, 95% CI 0.18-0.91, P = 0.03). Increased mortality was associated with bone fracture/osteomyelitis (HR 2.43, 95% CI 1.12-5.26, P = 0.03), tendon involvement (≥30% cross sectional area) (HR 3.78 95% CI 1.78-8.04, P = 0.001), duration of general anaesthesia (HR 1.01, 95% CI 1.00-1.02, P = 0.04), post-operative synoviocentesis (HR 3.18, 95% CI 1.36-7.43, P = 0.006) and post-operative wound dehiscence (HR 2.5, 95% CI 1.08-5.65, P = 0.04). Multivariable Cox proportional hazards model revealed reduced mortality after systemic antimicrobial administration prior to referral (HR 0.25, 95% CI 0.11-0.60, P = 0.002) and increased mortality with tendinous involvement (≥30% cross-sectional area) (HR 7.92, 95% CI 3.31-19.92, P<0.001). At follow-up (median 30 months, range 0.25-13 years, n = 70) 87.1% horses were alive, 7.1% had been euthanised due to the calcaneal injury and 5.7% had been euthanised for unrelated reasons. From 57 horses with athletic performance follow-up, 91.2% returned to the same/higher level of exercise, 5.3% to a lower level and 3.5% were retired due to persistent lameness of the affected limb. Conclusions: Retrospective study and incomplete follow-up. Conclusions: Endoscopic treatment of contamination/sepsis of the calcaneal bursae has an 84% survival rate to hospital discharge. Tendinous involvement reduced survival whilst systemic antimicrobials administration prior to referral improved survival.
© 2019 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2019-10-16 PubMed ID: 31502700PubMed Central: PMC7186813DOI: 10.1111/evj.13180Google Scholar: Lookup
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  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The study investigates factors that influence the survival of horses that undergo endoscopic treatment for synovial contamination or sepsis of the calcaneal bursa. The research found that horses that had been administered systemic antimicrobials before referral had a better chance of survival; whereas, horses with tendon involvement, among other factors, showed higher rates of mortality.

Research Methodology

  • In this study, a retrospective analysis of the medical records of 128 horses was performed. The horses had undergone endoscopic lavage treatment for contamination/sepsis of the calcaneal bursae at seven different equine hospitals.
  • Factors associated with survival of the horses were determined using descriptive statistics and Cox proportional hazards survival models.

Study Results

  • Of the horses that were analyzed, each underwent one to three surgeries.
  • The survival rate till hospital discharge was 84.4%.
  • Upon univariable survival analysis, it was found that horses that were administered systemic antimicrobials before referral showed reduced mortality.
  • Increased mortality was observed in cases associated with bone fracture/osteomyelitis, significant tendon involvement, longer duration of general anaesthesia, post-operative synoviocentesis and post-operative wound dehiscence.
  • The multivariable Cox proportional hazards model also showed reduced mortality after administration of systemic antimicrobials prior to referral and increased mortality with significant tendon involvement.
  • A follow-up after a median of 30 months showed that 7.1% of horses were euthanised due to the calcaneal injury and 5.7% were euthanised for unrelated reasons.

Related to Athletic Performance

  • From the 57 horses that were followed up for athletic performance, 91.2% of them returned to the same or a higher level of exercise and 5.3% returned to a lower level.
  • 3.5% of these horses had to be retired due to persistent lameness in the affected limb.

Conclusion

  • The study concluded that the endoscopic treatment of synovial contamination/sepsis of the calcaneal bursae in horses has an 84% survival rate to hospital discharge.
  • The likelihood of survival is improved with the administration of systemic antimicrobials prior to referral.
  • Furthermore, tendon involvement reduced survival chances.

Cite This Article

APA
Isgren CM, Salem SE, Singer ER, Wylie CE, Lipreri G, Graham RJTY, Bladon B, Boswell JC, Fiske-Jackson AR, Mair TS, Rubio-Martínez LM. (2019). A multi-centre cohort study investigating the outcome of synovial contamination or sepsis of the calcaneal bursae in horses treated by endoscopic lavage and debridement. Equine Vet J, 52(3), 404-410. https://doi.org/10.1111/evj.13180

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 52
Issue: 3
Pages: 404-410

Researcher Affiliations

Isgren, C M
  • Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.
  • Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Wirral, UK.
Salem, S E
  • Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Wirral, UK.
  • Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.
Singer, E R
  • Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.
Wylie, C E
  • Rossdales Equine Hospital, Exning, Newmarket, Suffolk, UK.
Lipreri, G
  • Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.
Graham, R J T Y
  • The Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Midlothian, UK.
Bladon, B
  • Donnington Grove Veterinary Group, Newbury, Oxfordshire, UK.
Boswell, J C
  • The Liphook Equine Hospital, Forest Mere, Liphook, Hampshire, UK.
Fiske-Jackson, A R
  • Equine Referral Hospital, Royal Veterinary College, North Mymms, Hertfordshire, UK.
Mair, T S
  • Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent, UK.
Rubio-Martínez, L M
  • Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.
  • Sussex Equine Hospital, West Sussex, UK.

MeSH Terms

  • Animals
  • Cohort Studies
  • Debridement / veterinary
  • Horse Diseases
  • Horses
  • Retrospective Studies
  • Sepsis / veterinary
  • Therapeutic Irrigation / veterinary
  • Treatment Outcome

Grant Funding

  • The Horserace Betting Levy Board

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