Retrospective evaluation of surgical site infection after open splenectomies with and without perioperative prophylactic antibiotic coverage

Abstract

Objectives Perioperative prophylactic antibiotics (PPA) are widely used in veterinary medicine to prevent surgical site infections (SSI). Current guidelines advocate the use in clean procedures only if surgeries exceed 90 minutes, or in patients with an ASA score ≥3. Procedure specific recommendations are currently lacking. The following study aimed to analyze the protective effect of PPA in dogs undergoing open splenectomy.

Methods The electronic database of our institution was searched for dogs that underwent splenectomy between 10/2017 and 01/2023. Data collection included age at presentation, breed, weight, reason for splenectomy, diagnosis, ASA class, PPA regime, surgery time, anesthesia time, lowest blood oxygen concentration during anesthesia, lowest body temperature, and lowest blood pressure during surgery as well as duration of hospitalization. Dogs were included if a follow-up of 30 days after surgery was available, or if death occurred within this timeframe.

Results A total of 112 dogs were included. Of these, 46 dogs received PPA, and 66 did not. Most dogs were classified ASA 3 or higher (PPA 87%, non-PPA 80.3%). One SSI (1.5% SSI rate) occurred in the non-PPA group (overall SSI rate 0.9%). Due to the low SSI rate, statistical analysis of risk factors for SSI development was not possible.

Conclusion The described infection rate of 1.5% without PPA indicates, that splenectomy does not qualify as high-risk surgery for SSI, even in patients with ASA class 3 or higher.

Clinical Relevance As splenectomies are frequently performed, the findings of the current study could have a major impact on the overall antimicrobial burden in routine veterinary practice.

Zusammenfassung

Einleitung Perioperative prophylaktische Antibiosen (PPA) werden in der Kleintiermedizin häufig eingesetzt um postoperative Infektionen (SSI) zu verhindern. Aktuelle Leitlinien empfehlen den Einsatz bei sauberen Eingriffen >90 Minuten oder bei Patienten mit ASA-Klasse ≥3. Eingriffsspezifische Empfehlungen fehlen jedoch bislang. Ziel dieser Studie war es, die protektive Wirkung von PPA bei offenen Splenektomien beim Hund zu erfassen.

Methoden Die elektronische Datenbank unseres Instituts wurde retrospektiv nach Hunden, die zwischen 10/2017 und 01/2023 einer Splenektomie unterzogen wurden, durchsucht. Alter, Rasse, Gewicht, Grund für die Splenektomie, Diagnose, ASA-Klasse sowie das PPA-Regime, die Operationszeit, die Anästhesiezeit, die niedrigste Blutsauerstoffkonzentration, Körpertemperatur und der niedrigste Blutdruck während der Anästhesie sowie die Dauer der Hospitalisation wurden erfasst. Hunde wurden eingeschlossen, wenn Informationen über den klinischen Verlauf bis zu Tag 30 bekannt waren (auch wenn die Hunde während dieser Zeit verstarben).

Ergebnisse Es wurden 112 Hunde eingeschlossen. Von diesen erhielten 46 Hunde eine PPA und 66 nicht. Die meisten Hunde wurden als ASA 3 oder höher eingestuft (87% mit PPA, 80,3% ohne PPA). Bei einem Hund ohne PPA trat eine Infektion auf (SSI-Rate insgesamt 0,9%, 1,5% ohne PPA). Aufgrund der niedrigen SSI-Rate war es nicht möglich, den Einfluss der erfassten Faktoren auf die Infektionsrate zu ermitteln.

Schlussfolgerung Die beschriebene Infektionsrate von 1,5% ohne PPA deutet darauf hin, dass eine Splenektomie selbst bei Patienten mit ASA-Klasse ≥3 keinen Risikoeingriff für postoperative Infektionen darstellt.

Klinische Relevanz Da Splenektomien häufig durchgeführt werden, könnten die Ergebnisse der aktuellen Studie einen großen Einfluss auf die Gesamtmenge der eingesetzten Antibiotika in der Kleintierchirurgie haben.

Key words

Surgical site infection - clean surgery - ASA class - Ligasure - prophylactic antibiotics - short-term survival

Schlüsselwörter

Postoperative Infektionen - Saubere Operation - ASA Klasse - Ligasure - prophylaktische Antibiotikatherapie - Kurzzeit-Überlebensrate

Publication History

Received: 28 January 2023

Accepted: 05 May 2023

Article published online:
11 August 2023

• References

• 1 Ierano C, Thursky K, Marshall C. et al. Appropriateness of Surgical Antimicrobial Prophylaxis Practices in Australia. JAMA Netw Open 2019; 2: e1915003
• 2 Allerton F, Prior C, Bagcigil AF. et al. Overview and Evaluation of Existing Guidelines for Rational Antimicrobial Use in Small-Animal Veterinary Practice in Europe. Antibiotics (Basel) 2021; 10: 409
• 3 Nelson LL. Surgical site infections in small animal surgery. Vet Clin North Am Small Anim Pract 2011; 41: 1041-1056
• 4 Verwilghen D, Singh A. Fighting surgical site infections in small animals: are we getting anywhere?. Vet Clin North Am Small Anim Pract 2015; 45: 243-276
• 5 Jessen LRDP, Spohr A, Goericke-Pesch S. et al Antibiotic Use Guidelines for Companion Animal Practice: Companion Animal Group, Danish Veterinary Association. 2000 Available from https://www.ddd.dk/media/2175/assembled_final.pdf
• 6 Schuller SSS, Willy B. Umsichtiger Einsatz von Antibiotika bei Hunden und Katzen Therapieleitfaden für Tierärztinnen und Tierärzte. 2019 Available from https://www.blv.admin.ch/blv/de/home/tiere/tierarzneimittel/antibiotika/nationale-strategie-antibiotikaresistenzen--star--/sachgemaesser-antibiotikaeinsatz.html
• 7 Brown DC, Conzemius MG, Shofer F. et al. Epidemiologic evaluation of postoperative wound infections in dogs and cats. Journal of the American Veterinary Medical Association 1997; 210: 1302-1306
• 8 Daude-Lagrave A, Carozzo C, Fayolle P. et al. Infection rates in surgical procedures: a comparison of cefalexin vs. a placebo. Vet Comp Orthopaed 2001; 14: 146-150
• 9 Stetter J, Boge GS, Gronlund U. et al. Risk factors for surgical site infection associated with clean surgical procedures in dogs. Res Vet Sci 2021; 136: 616-621
• 10 Turk R, Singh A, Weese JS. Prospective Surgical Site Infection Surveillance in Dogs. Veterinary Surgery 2015; 44: 2-8
• 11 Vasseur PB, Levy J, Dowd E. et al. Surgical wound infection rates in dogs and cats. Data from a teaching hospital. Vet Surg 1988; 17: 60-64
• 12 Vasseur PB, Paul HA, Enos LR. et al. Infection rates in clean surgical procedures: a comparison of ampicillin prophylaxis vs a placebo. J Am Vet Med Assoc 1985; 187: 825-827
• 13 CDC. Surgical Site Infection Event (SSI) 2022. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
• 14 Horan TC, Gaynes RP, Martone WJ. et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992; 20: 271-284
• 15 Richmond BK. Everything Old is New Again: Applying the Lessons from Halsted's Life and Work to Today's Surgical Landscape. Am Surg 2022; 88: 1405-1410
• 16 Alexander CK, Cronin KL, Silver M. et al. The addition of metronomic chemotherapy does not improve outcome for canine splenic haemangiosarcoma. J Small Anim Pract 2019; 60: 32-37
• 17 Cleveland MJ, Casale S. Incidence of malignancy and outcomes for dogs undergoing splenectomy for incidentally detected nonruptured splenic nodules or masses: 105 cases (2009–2013). J Am Vet Med Assoc 2016; 248: 1267-1273
• 18 Dongaonkar KR, Linden D, Davidson JR. et al. Partial splenectomy for incidentally detected non-ruptured splenic lesions in dogs: 18 cases (2004–2018). Can Vet J 2019; 60: 1194-1198
• 19 Latifi M, Tuohy JL, Coutermarsh-Ott SL. et al. Clinical outcomes in dogs with localized splenic histiocytic sarcoma treated with splenectomy with or without adjuvant chemotherapy. J Vet Intern Med 2020; 34: 2645-2650
• 20 Lynch AM, O'Toole TE, Hamilton J. Transfusion practices for treatment of dogs undergoing splenectomy for splenic masses: 542 cases (2001–2012). J Am Vet Med Assoc 2015; 247: 636-642
• 21 McGaffey MES, Singh A, Buote NJ. et al. Complications and outcomes associated with laparoscopic-assisted splenectomy in dogs. J Am Vet Med Assoc 2022; 260: 1309-1315
• 22 Millar SL, Curley TL, Monnet EL. et al. Premature death in dogs with nontraumatic hemoabdomen and splenectomy with benign histopathologic findings. J Am Vet Med Assoc 2021; 260: 9-14
• 23 Modesto Donate R, Cairo Soler C, Gomez Castro S. [Health in Cuba]. Enferm Intensiva 1995; 6: 84-90
• 24 Sirochman AL, Milovancev M, Townsend K. et al. Influence of use of a bipolar vessel sealing device on short-term postoperative mortality after splenectomy: 203 dogs (2005–2018). Vet Surg 2020; 49: 291-303
• 25 Story AL, Wavreille V, Abrams B. et al. Outcomes of 43 small breed dogs treated for splenic hemangiosarcoma. Vet Surg 2020; 49: 1154-1163
• 26 van Stee LL, Boston SE, Singh A. et al. Outcome and Prognostic Factors for Canine Splenic Lymphoma Treated by Splenectomy (1995–2011). Vet Surg 2015; 44: 976-982
• 27 Wendelburg KM, O'Toole TE, McCobb E. et al. Risk factors for perioperative death in dogs undergoing splenectomy for splenic masses: 539 cases (2001-2012). J Am Vet Med Assoc 2014; 245: 1382-1390
• 28 Wendelburg KM, Price LL, Burgess KE. et al. Survival time of dogs with splenic hemangiosarcoma treated by splenectomy with or without adjuvant chemotherapy: 208 cases (2001–2012). J Am Vet Med Assoc 2015; 247: 393-403
• 29 Mayhew PD, Sutton JS, Singh A. et al. Complications and short-term outcomes associated with single-port laparoscopic splenectomy in dogs. Vet Surg 2018; 47: 67-74
• 30 Wright T, Singh A, Mayhew PD. et al. Laparoscopic-assisted splenectomy in dogs: 18 cases (2012–2014). J Am Vet Med Assoc 2016; 248: 916-922
• 31 Dyall BAR, Schmokel HG. Surgical Site Infection Rate after Hemilaminectomy and Laminectomy in Dogs without Perioperative Antibiotic Therapy. Vet Comp Orthop Traumatol 2018; 31: 202-213
• 32 Monarski CJ, Jaffe MH, Kass PH. Decreased surgical time with a vessel sealing device versus a surgical stapler in performance of canine splenectomy. J Am Anim Hosp Assoc.