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

C M Isgren, S E Salem, E R Singer, C E Wylie, G Lipreri, R J T Y Graham, B Bladon, J C Boswell, A R Fiske-Jackson, T S Mair, L M Rubio-Martínez

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Previous studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited.

OBJECTIVES: To investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections.

STUDY DESIGN: Retrospective analysis of clinical records.

METHODS: Medical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow-up questionnaire was used to determine survival and return to athletic performance. Descriptive statistics and Cox proportional hazards survival models were used to determine factors associated with survival.

RESULTS: Horses underwent one (n = 107), two (n = 19), or three (n = 2) surgeries. Survival to hospital discharge was 84.4%. Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (Hazard Ratio, (HR) 0.41, 95% CI 0.18-0.91, P = 0.03). Increased mortality was associated with bone fracture/osteomyelitis (HR 2.43, 95% CI 1.12-5.26, P = 0.03), tendon involvement (≥30% cross sectional area) (HR 3.78 95%CI 1.78-8.04, P = 0.001), duration of general anaesthesia (HR 1.01, 95%CI 1.00-1.02, P = 0.04), post-operative synoviocentesis (HR 3.18, 95%CI 1.36-7.43, P = 0.006) and post-operative wound dehiscence (HR 2.5, 95%CI 1.08-5.65, P = 0.04). Multivariable Cox proportional hazards model revealed reduced mortality after systemic antimicrobial administration prior to referral (HR 0.25, 95%CI 0.11-0.60, P = 0.002) and increased mortality with tendinous involvement (≥30% cross sectional area) (HR 7.92, 95%CI 3.31-19.92, P<0.001). At follow-up (median 30 months, range 0.25-13 years, n = 70) 87.1% horses were alive, 7.1% had been euthanised due to the calcaneal injury and 5.7% had been euthanised for unrelated reasons. From 57 horses with athletic performance follow-up, 91.2% returned to the same/higher level of exercise, 5.3% to a lower level and 3.5% were retired due to persistent lameness of the affected limb.

MAIN LIMITATIONS: Retrospective study and incomplete follow-up.

CONCLUSION: Endoscopic treatment of contamination/sepsis of the calcaneal bursae has an 84% survival rate to hospital discharge. Tendinous involvement reduced survival whilst systemic antimicrobials administration prior to referral improved survival.

Original languageEnglish
JournalEquine Veterinary Journal
Early online date10 Sep 2019
DOIs
Publication statusE-pub ahead of print - 10 Sep 2019

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