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Veterinary surgery : VS2026; doi: 10.1111/vsu.70061

Application of a framework to mitigate the risk of surgical site infection after exploratory celiotomy in horses: A retrospective study.

Abstract: To describe the methodology used to identify the contributors to a perceived sudden increase in exploratory celiotomy surgical site infections (SSI) and complications at the North Carolina State University Veterinary Teaching Hospital (NCSU VTH) between 2019 and 2020 and evaluate the effect of the designed intervention up to 4 years after its implementation. Methods: Case-control retrospective study over a five-year period. Methods: A total of 448 horses that underwent exploratory celiotomy for the treatment of acute abdominal pain were included. Methods: Medical records of horses that underwent exploratory celiotomy between 2019-2024 were reviewed from software systems used at the NCSU VTH. A surgical audit was conducted to assess adherence to best practices and identify factors contributing to increased SSI incidence. This led to the development of an evidence-based intervention to address procedural deficiencies and incorporate preventative perioperative strategies. The approach, resultant protocols, and reduction of SSI incidence are described. Data were analyzed using Fisher's exact test and univariate logistic regression. Statistical significance was set to p < .05. Results: A significant increase in %SSI was observed from 7.7% in 2019 to 29% in 2020 (p = .0067). Following new protocol implementation, %SSI decreased to 2.3%. Conclusions: A surgical audit enabled the development of an evidence-based intervention that significantly reduced SSI incidence after exploratory celiotomy surgery. Conclusions: Surgical audits serve as critical quality-of-care measure, allowing hospitals to identify procedural deficiencies. There is currently no literature that describes structured processes to manage this kind of problem in veterinary medicine. Surgical audit implementation may help other hospitals faced with similar challenges.
© 2026 The Author(s). Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.
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Publication Date: 2026-03-03 PubMed ID: 41776752DOI: 10.1111/vsu.70061Google Scholar: Lookup
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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.

Overview

  • This study analyzed the causes behind a sudden increase in surgical site infections (SSI) following exploratory celiotomy in horses at a veterinary hospital, developed an intervention to address procedural issues, and then evaluated the intervention’s effectiveness over several years.
  • After implementing new protocols based on a detailed surgical audit, the rate of SSIs dropped significantly, demonstrating that systematic review and process improvement can enhance surgical outcomes in veterinary medicine.

Introduction and Background

  • Exploratory celiotomy is a surgical procedure performed on horses to treat acute abdominal pain by opening the abdomen to diagnose or treat internal conditions.
  • Surgical site infections (SSI) are a common and serious complication that can occur after such surgeries, leading to prolonged recovery, additional treatments, and increased costs.
  • At North Carolina State University Veterinary Teaching Hospital (NCSU VTH), a sharp increase in SSIs was noticed between 2019 and 2020—a jump from 7.7% to 29% incidence rate, which raised concerns about existing surgical processes.
  • The hospital wanted to systematically investigate the causes of this increased infection rate and implement strategies to reduce SSIs.

Study Design and Methods

  • Type of study: Retrospective case-control study conducted over a five-year period (2019–2024).
  • Subjects: 448 horses underwent exploratory celiotomy for acute abdominal pain were included for review.
  • Data sources: Medical records from the NCSU VTH electronic software systems were reviewed to collect information on surgical practices, infection rates, and outcomes.
  • Surgical audit: A thorough audit assessed adherence to best practices in surgery with the aims of identifying procedural lapses or deficiencies that could have contributed to the spike in SSIs.
  • Development of intervention: Based on audit findings, the team created an evidence-based intervention protocol targeting identified weaknesses, including:
    • Implementation of preventative perioperative strategies
    • Standardization of surgical procedures and hygiene practices
    • Better monitoring and documentation procedures
  • Statistical analysis: Fisher’s exact test and univariate logistic regression were used to evaluate SSI incidence changes, with significance set at p < 0.05.

Key Findings

  • There was a statistically significant increase in SSIs from 7.7% in 2019 to 29% in 2020 (p = 0.0067), confirming a clear problem.
  • After the new surgical protocols were implemented, the SSI rate dramatically dropped to 2.3%, demonstrating the effectiveness of the intervention.
  • The audit and intervention effectively identified and addressed procedural factors related to infection control.

Conclusions and Implications

  • The study highlights surgical audits as a critical quality assurance tool that can identify root causes of complications in a clinical setting.
  • Implementing evidence-based, structured interventions following audits can significantly reduce infection rates after surgery.
  • Currently, there is a lack of published literature on structured approaches to managing surgical complications like SSIs in veterinary medicine; this study fills an important gap.
  • Other veterinary hospitals facing similar issues can consider adopting surgical audits and tailored interventions to improve patient outcomes.

Cite This Article

APA
Lopez Cruz C, Gonzalez LM, McKinney-Aguirre CA, Hepworth-Warren KL, Roessner HA, Burke M, Fogle CA. (2026). Application of a framework to mitigate the risk of surgical site infection after exploratory celiotomy in horses: A retrospective study. Vet Surg. https://doi.org/10.1111/vsu.70061

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English

Researcher Affiliations

Lopez Cruz, Carla
  • Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA.
Gonzalez, Liara M
  • Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA.
McKinney-Aguirre, Caroline A
  • Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA.
Hepworth-Warren, Kate L
  • Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA.
Roessner, Holly A
  • Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA.
Burke, Megan
  • Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA.
Fogle, Callie A
  • Department of Veterinary Clinical Sciences, Clemson University, Clemson, South Carolina, USA.

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