Evaluation of long-term postoperative morbidity and survival after equine colic surgery using a complication severity classification.

Overview

• This study assessed the long-term survival and postoperative complications in horses following colic surgery using a standardized complication scoring system called the Equine Postoperative Complication Score (EPOCS).
• The research aimed to understand how complications influence survival beyond the immediate postoperative period, addressing a gap in existing literature that largely focuses on short-term outcomes.

Background and Purpose

• Colic surgery in horses is a common emergency intervention, but most research concentrates on survival and complications during the hospital stay or shortly after surgery.
• Long-term postoperative morbidity—complications occurring after discharge—is not well documented, despite its importance for horse owners and veterinarians.
• Prior to this study, no standardized system had been used to integrate both short-term and long-term postoperative complications with survival data.
• The study introduced the Equine Postoperative Complication Score (EPOCS) as a tool to systematically quantify complications over time.

Methods

• The researchers conducted a retrospective review of medical records from a single center, including horses that underwent colic surgery between January 2017 and March 2021.
• Long-term follow-up was obtained by telephone at least 4 years post-surgery to assess survival and record post-discharge complications.
• Complications were scored using EPOCS, a severity classification system, to evaluate morbidity in a structured way.
• Statistical analysis was applied to explore correlations between complication scores and survival outcomes.

Key Findings

• Out of 244 treated horses, 203 survived to discharge and 176 were successfully followed up long term.
• Post-discharge complications were fairly common, occurring in 44.8% of horses, with recurrent colic episodes being the most frequently reported issue.
• Higher complication scores recorded before discharge (pre-discharge EPOCS) were significantly associated with reduced long-term survival.
• When considering the total complication score (including both pre- and post-discharge periods), there remained an inverse relationship with survival.
• Post-discharge complications alone (post-discharge EPOCS) did not show a significant association with survival, indicating early complications might be more prognostically relevant.
• Neither the type of intestinal lesion, the specific intestinal segment affected, nor whether resection surgery was performed, had a significant impact on survival rates.

Interpretation and Implications

• The findings suggest that colic surgery has a generally favorable long-term survival rate for horses.
• However, postoperative complications remain common and can influence prognosis, especially those occurring before discharge.
• EPOCS proved to be a useful tool in quantifying complications systematically, enabling better comparisons and possibly guiding clinical decisions or management practices in the future.

Limitations

• The retrospective design of the study may introduce bias in data collection and completeness.
• Follow-up data were owner-reported via telephone, which can lead to under-reporting of minor complications and reliance on owner recall accuracy.
• Data were collected from a single center, which may limit the applicability of the results to other populations or clinical settings.

Conclusions

• Long-term survival after equine colic surgery is generally good, but postoperative morbidity is frequent and important for prognosis.
• The use of a standardized score like EPOCS allows for better tracking and understanding of postoperative complications over time.
• This scoring system could support future research comparing surgical techniques and postoperative management to improve outcomes.