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BMC veterinary research2017; 13(1); 155; doi: 10.1186/s12917-017-1069-5

A retrospective analysis of the risk factors for surgical site infections and long-term follow-up after transpalpebral enucleation in horses.

Abstract: Implants are often used to improve the cosmetic appearance of horses after enucleation of the eye. When surgical site infection (SSI) occurs, the implant will almost always be lost. The aim of this study is to collect data on the risk factors for SSIs and report long-term follow-up (cosmetic results and return to work) after transpalpebral enucleations. In this retrospective study, records of horses undergoing transpalpebral enucleation were reviewed (2007-2014) and telephone interviews were used to obtain long term follow-up. The potential risk factors for SSIs (indication for enucleation, use of an implant, standing procedures, duration of surgery, opening of the conjunctival sac and prolonged use of antimicrobials) were analysed for their association with the outcome measure 'SSI' vs 'no SSI' by multivariable binary logistic regression testing. Indications for enucleation were grouped as follows: Group 1 (clean) included equine recurrent uveitis, too small or too large globes, and intraocular tumours, Group 2 (non-clean) included corneal perforation/rupture and infected ulcers and Group 3 (tumour) included extraocular tumours. Results: One hundred and seven cases of enucleation were evaluated. An implant was used in 49 horses. The overall number of SSIs was 8 (7.5%). Multivariable logistic regression testing showed implants (OR 7.5, P = 0.04) and standing procedures (OR 12.1; P = 0.03) were significantly associated with the percentage of SSIs and increased the risk of SSI. The eyes of horses in Groups 2 and 3 trended towards a larger risk for developing SSIs (OR 4.9; P = 0.09 and OR 5.9; P = 0.1, respectively). Prolonged use of antimicrobials, long surgery times and the opening of the conjunctival sac during dissection did not show significant associations with SSI risk. Conclusions: The risk of SSI after enucleation is low in clean eyes and when no implant is used. Placing an implant or performing a standing enucleation significantly increases the risk of SSIs. Although implants can be used for eyes that fall into Groups 2 and 3, 17% of the horses in these two groups developed an SSI leading to loss of the implant.
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Publication Date: 2017-06-02 PubMed ID: 28578668PubMed Central: PMC5457630DOI: 10.1186/s12917-017-1069-5Google Scholar: Lookup
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Summary

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The research article retrospectively analyzes the risk factors associated with surgical site infections (SSIs) in horses, following eye removal procedures known as enucleation. It sheds light on how cosmetic implants used after these procedures can potentially increase SSI risk, and presents a long-term follow-up to gauge cosmetic and practical success.

About the Study

  • This is a retrospective study, which implies the researchers examined existing data rather than conducting a fresh experiment or trial.
  • They examined records of horses undergoing enucleation, a surgery performed to remove the eye completely, between 2007 and 2014.
  • Additional data was gathered through follow-up telephone interviews.

Risk Factors for Surgical Site Infections

  • Surgical Site Infections (SSIs) are a common risk associated with any surgical procedure. In this study, the researchers focus specifically on SSIs following horse enucleation surgeries.
  • Various potential risk factors for SSIs were examined. These include: the reason for enucleation, the use of an implant, the horse standing during procedures, the duration of the surgery, opening of the conjunctival sac, and prolonged use of antimicrobials.
  • To determine the risk factors, the researchers used a statistical method known as multivariable binary logistic regression testing. This method helped draw conclusions about how these factors might influence ‘SSI’ versus ‘no SSI’ outcomes.

Enucleation Groupings

  • The horses’ enucleation surgeries were categorized into three groups based on their medical situation: Group 1 was ‘clean’ (equine recurrent uveitis, size issues, or intraocular tumors), Group 2 was ‘non-clean’ (corneal perforation/rupture, infected ulcers), and Group 3 ‘tumour’ (extraocular tumors).

Study Results

  • A total of 107 enucleation cases were evaluated, with implants used in 49 horses.
  • The overall number of SSIs was 8 (7.5% of cases), indicating that SSIs are relatively uncommon after this type of surgery.
  • The usage of implants and standing procedures were significantly associated with the occurrence of SSIs, implying they increase the risk.
  • Horses in groups 2 and 3 were more likely to develop SSIs, although not in a statistically significant way.
  • Factors such as antimicrobial usage, surgery duration, or opening the conjunctival sac were not significantly linked to SSI risk.

Conclusions

  • The study concluded that in clean surgeries without implants, the risk of SSI is low.
  • However, when implants are used or the procedure is performed while the horse is standing, this significantly increases the risk of developing an SSI.
  • For horses falling into the group 2 and 3 categories, despite an implant potentially being usable, there was a noted 17% SSI development leading to implant loss.

Cite This Article

APA
Huppes T, Hermans H, Ensink JM. (2017). A retrospective analysis of the risk factors for surgical site infections and long-term follow-up after transpalpebral enucleation in horses. BMC Vet Res, 13(1), 155. https://doi.org/10.1186/s12917-017-1069-5

Publication

BMC veterinary research
ISSN: 1746-6148
NlmUniqueID: 101249759
Country: England
Language: English
Volume: 13
Issue: 1
Pages: 155

Researcher Affiliations

Huppes, Tsjester
  • Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM, Utrecht, Netherlands. t.huppes@uu.nl.
Hermans, Hanneke
  • Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM, Utrecht, Netherlands.
Ensink, Jos M
  • Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM, Utrecht, Netherlands.

MeSH Terms

  • Eye Enucleation / adverse effects
  • Eye Enucleation / methods
  • Eye Enucleation / veterinary
  • Follow-Up Studies
  • Orbital Implants / veterinary
  • Retrospective Studies
  • Risk Factors
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / veterinary

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Citations

This article has been cited 4 times.
  1. Dagenais A, Juette T, Benoit-Biancamano MO, Vanore M. Reducing Recurrence in Equine Corneolimbal SCC: Outcomes of Adjunctive Cisplatin Biodegradable Bead Therapy. Vet Sci 2026 Jan 12;13(1).
    doi: 10.3390/vetsci13010076pubmed: 41600732google scholar: lookup
  2. Farkas A, Thieme K, Soimala T, Jensen CK, Eule JC. Efficacy of 0.2% povidone-iodine and 0.1% polyhexamethylene biguanide as preoperative antiseptics in equine ophthalmic procedures. Vet Ophthalmol 2025 Mar;28(2):438-447.
    doi: 10.1111/vop.13306pubmed: 39648293google scholar: lookup
  3. Marzok M, Almubarak AI, Nazih M, Al-Thnaian TA, Alkhodair K, El-Sherif M. A novel enucleation- exenteration approach of the equine eye via the supraorbital fossa: an experimental and clinical study in donkeys (Equus asinus). Front Vet Sci 2024;11:1379151.
    doi: 10.3389/fvets.2024.1379151pubmed: 38948677google scholar: lookup
  4. Dacanay SJ, Barber RM, Diehl KA, Myrna KE. Incidence and risk factors for surgical site infection following enucleation in dogs. Front Vet Sci 2022;9:1086956.
    doi: 10.3389/fvets.2022.1086956pubmed: 36713880google scholar: lookup
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