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Equine veterinary journal2014; 46(6); 701-705; doi: 10.1111/evj.12212

Factors associated with survival to hospital discharge following endoscopic treatment for synovial sepsis in 214 horses.

Abstract: To determine risk factors involved in survival to hospital discharge of cases of synovial sepsis. Objective: Investigate pre-, intra- and post operative factors involved in short-term survival of horses undergoing endoscopic treatment for synovial sepsis. Methods: Retrospective case series. Methods: Clinical data were obtained for horses (>6 months old) undergoing endoscopic surgery as part of management for synovial sepsis over a 7-year period in a single hospital population. Descriptive data were generated for pre-, intra- and post operative variables. Multivariable logistic regression analysis was used to develop 3 models related to presurgical, surgical and post surgical stages of management with outcome defined as survival to hospital discharge. Results: Two hundred and fourteen horses were included. In Model 1 (preoperative variables), increased preoperative synovial fluid total protein (TP) was associated with nonsurvival (OR 0.88, 95% CI 0.83-0.94, P<0.001) whereas the presence of a wound on admission was associated with survival (OR 4.75, 95% CI 1.21-18.65, P = 0.02). Model 2 (intraoperative variables) revealed that factors associated with decreased survival were anaesthetic induction outside of normal working hours (OR 0.36, 95% CI 0.15-0.88 P = 0.02) and presence of moderate/severe synovial inflammation at surgery (OR 0.28, 95% CI 0.12-0.67, P = 0.004). Model 3 (post operative variables) showed that increased post operative synovial fluid TP (OR 0.94, 95% CI 0.90-0.98, P = 0.013) and undertaking more than one endoscopic surgery for treatment (OR 0.19, 95% CI 0.05-0.70, P = 0.005) were associated with nonsurvival. Cut-off values for predicting survival were 55-60 g/l for preoperative and 50-55 g/l for post operative TP measurements. Conclusions: This study has identified factors associated with altered likelihood of survival to hospital discharge following endoscopic surgery for synovial sepsis. Prognosis for survival to hospital discharge can be based on evidence from this study at the key stages of management of horses with synovial sepsis.
© 2013 EVJ Ltd.
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Publication Date: 2014-01-12 PubMed ID: 24417437DOI: 10.1111/evj.12212Google Scholar: Lookup
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Summary

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The research paper explores the risk factors associated with the survival of horses discharged from hospital following endoscopic treatment for synovial sepsis. Using a model that considers pre-, intra- and post-operative stages, the study identifies key outcome determinants like preoperative synovial fluid protein level, anesthetic induction time, presence of wound, and the extent of synovial inflammation.

Research Methodology

  • The study is based on the clinical data obtained from horses that were over 6 months old and underwent endoscopic surgery to treat synovial sepsis in a single hospital over a 7-year period.
  • Descriptive data were generated for various preoperative, intraoperative, and postoperative variables.
  • Using multivariable logistic regression analysis, three separate models were created, representing presurgical, surgical, and post-surgical stages of management. Survival to hospital discharge was defined as the outcome.

Results and Findings

  • The study included 214 horses. In Model 1 focusing on preoperative variables, an increased preoperative synovial fluid total protein (TP) level was associated with a lower survival rate (OR 0.88, 95% CI 0.83-0.94), while the presence of a wound on admission was associated with survival (OR 4.75, 95% CI 1.21-18.65).
  • In the second model revolving around intraoperative variables, anesthetic induction outside of normal working hours (OR 0.36, 95% CI 0.15-0.88) and the presence of moderate/severe synovial inflammation at the time of surgery (OR 0.28, 95% CI 0.12-0.67) were associated with decreased likelihood of survival.
  • The third model concerned with post-operative variables showed that an increased post-operative synovial fluid TP (OR 0.94, 95% CI 0.90-0.98) and undergoing more than one endoscopic surgery for treatment (OR 0.19, 95% CI 0.05-0.70) were associated with nonsurvival.
  • Predictive cut-off values for survival were 55-60 g/l for preoperative and 50-55 g/l for post-operative TP measurements.

Conclusions

  • The research identified that specific factors at various stages of management of horses with synovial sepsis can alter the likelihood of survival to hospital discharge after endoscopic surgery.
  • The prognosis for survival to hospital discharge can be based on evidence from this research, providing valuable assistance in veterinary care and treatment planning for horses with synovial sepsis.

Cite This Article

APA
Milner PI, Bardell DA, Warner L, Packer MJ, Senior JM, Singer ER, Archer DC. (2014). Factors associated with survival to hospital discharge following endoscopic treatment for synovial sepsis in 214 horses. Equine Vet J, 46(6), 701-705. https://doi.org/10.1111/evj.12212

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 46
Issue: 6
Pages: 701-705

Researcher Affiliations

Milner, P I
  • Institute of Ageing and Chronic Disease, University of Liverpool, Neston, UK.
Bardell, D A
    Warner, L
      Packer, M J
        Senior, J M
          Singer, E R
            Archer, D C

              MeSH Terms

              • Animals
              • Arthroscopy / veterinary
              • Horse Diseases / pathology
              • Horse Diseases / surgery
              • Horses
              • Hospitals, Animal
              • Logistic Models
              • Odds Ratio
              • Retrospective Studies
              • Risk Factors
              • Sepsis / mortality
              • Sepsis / surgery
              • Sepsis / veterinary

              Citations

              This article has been cited 11 times.
              1. Albanese V, Straticò P, Fischer H, Petrizzi L. Equine Distal Limb Wounds: Economic Impact and Short-Term Prognosis of Non-Synovial Versus Synovial Lesions in Southern Germany. Vet Sci 2025 Mar 1;12(3).
                doi: 10.3390/vetsci12030205pubmed: 40266953google scholar: lookup
              2. Isgren CM, Pinchbeck GL, Salem SE, Hann MJ, Townsend NB, Cullen MD, Archer DC. Evaluation of a stent dressing and abdominal bandage on surgical site infection following emergency equine laparotomy: A randomised controlled trial. Equine Vet J 2025 Nov;57(6):1466-1477.
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                doi: 10.1002/vms3.1501pubmed: 38923315google scholar: lookup
              4. Rockow M, Griffenhagen G, Landolt G, Hendrickson D, Pezzanite L. Current Antimicrobial Use in Horses Undergoing Exploratory Celiotomy: A Survey of Board-Certified Equine Specialists. Animals (Basel) 2023 Apr 22;13(9).
                doi: 10.3390/ani13091433pubmed: 37174470google scholar: lookup
              5. Vajs T, Nekouei O, Biermann NM. A Descriptive Study of the Clinical Presentation, Management, and Outcome of Horses with Acute Soft Tissue Trauma of the Tarsus and the Association with Synovial Involvement. Animals (Basel) 2022 Feb 21;12(4).
                doi: 10.3390/ani12040524pubmed: 35203232google scholar: lookup
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                doi: 10.1111/evj.13459pubmed: 33977535google scholar: lookup
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                doi: 10.3389/fvets.2019.00367pubmed: 31696123google scholar: lookup
              8. Stack JD, Cousty M, Steele E, Handel I, Lechartier A, Vinardell T, David F. Comparison of Serum Amyloid A Measurements in Equine Synovial Fluid With Routine Diagnostic Methods to Detect Synovial Infection in a Clinical Environment. Front Vet Sci 2019;6:325.
                doi: 10.3389/fvets.2019.00325pubmed: 31632987google scholar: lookup
              9. Isgren CM, Salem SE, Singer ER, Wylie CE, Lipreri G, Graham RJTY, Bladon B, Boswell JC, Fiske-Jackson AR, Mair TS, Rubio-Martínez LM. 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 2020 May;52(3):404-410.
                doi: 10.1111/evj.13180pubmed: 31502700google scholar: lookup
              10. Robinson CS, Singer ER, Piviani M, Rubio-Martinez LM. Are serum amyloid A or D-lactate useful to diagnose synovial contamination or sepsis in horses?. Vet Rec 2017 Oct 21;181(16):425.
                doi: 10.1136/vr.104386pubmed: 28765498google scholar: lookup
              11. Haltmayer E, Schwendenwein I, Licka TF. Course of serum amyloid A (SAA) plasma concentrations in horses undergoing surgery for injuries penetrating synovial structures, an observational clinical study. BMC Vet Res 2017 May 22;13(1):137.
                doi: 10.1186/s12917-017-1057-9pubmed: 28532514google scholar: lookup
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