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Reducing Surgical Infections — What You Need to Know

Analysis by Dr. Karen Shaw Becker

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Story at-a-glance -

  • The incidence of postsurgical infections in dogs is an understudied topic
  • Estimates are that 3% to 6% of dogs develop postsurgical infections, and a recent study reveals several important findings
  • Corticosteroids and pre-existing hyperglycemia appear to increase the risk for surgical site infections, as do procedures lasting over an hour, the use of urinary catheters, and foregoing use of E-collars
  • Therapeutic massage can be an invaluable tool in helping post-op patients heal and return to full mobility

A recently published study in the journal BMJ Vet Record sheds some much-needed light on postsurgical infections in dogs. According to the study authors, "These infections are responsible for an increase in morbidity, mortality, prolonged hospital stay, increased costs, and a negative impact on the emotional state of the owner."1

From 3% to 6.6% of Dogs Develop Postsurgical Infections

Current estimates are that from 3% to 6.6% of dogs develop infections following surgery. The researchers used information from a veterinary teaching hospital where 184 male and female dogs of all ages underwent soft tissue surgery during a 12-month period (October 2013 to September 2014).

The research team collected details on the health of the dogs following surgery, as well as their breed, age, sex, reproductive status, and underlying health conditions. They also compiled data on the procedures performed, including the type and length of the surgery, how many people participated (including undergraduates), how the wound was sealed, and the type of surgical scrub the surgeons used.

The researchers used an “active surveillance system” to monitor the dogs after surgery. They completed assessments in the hospital at 5- and 10-days postsurgery, and also followed up at the 30-day mark with a telephone call. This system revealed a higher rate of infections than earlier studies that did not use such a system.

Study Results Reveal Important Insights for Veterinary Surgical Teams

Of the 184 procedures performed, surgical site infections (SSIs) occurred in 16 cases (8.7%). While the dogs’ age, sex, and breed weren’t found to affect the risk of SSI, the study authors did identify a number of other factors that were associated with an increased risk:

  • Steroidal anti-inflammatory drugs (corticosteroids, e.g., prednisone and prednisolone) increased the risk of infection, a finding that is new to veterinary science. According to study authors, this could be due to the fact that these drugs cause suppression of the immune system, which makes infection more likely.
  • The risk of SSI was greater for dogs with higher-than-normal blood glucose levels (hyperglycemia) before their surgeries. Although researchers have not shown this link in animals before, hyperglycemia is a known risk factor for SSI in humans. Studies show that hyperglycemia hampers the ability of white blood cells to pass through the walls of capillaries, preventing them from reaching the site of infection.
  • SSI risk was also increased for dogs whose surgeries lasted beyond one hour; in human medicine, long surgery times are also associated with a higher risk of SSI.
  • Dogs who required a urinary catheter had a higher risk of infection. This is yet another new finding for veterinary medicine that might be explained by a well-established link between catheters and urinary tract infections (UTIs). According to study authors, "[T]he microorganisms responsible for the development of UTIs could easily be involved in the colonization of surgical wounds."
  • Dogs who didn’t receive an Elizabethan collar (the “cone of shame”) after surgery were found to have an increased risk of infection. According to the study authors, this "could be explained by the existence of [a] certain degree of self-mutilation in veterinary patients when the healing surgical wound is not protected." Said another way, bacteria from a dog's mouth can pass freely to an unprotected surgical site and cause an infection.
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Surgical Infections Are Costly and Compromise Pets’ Health

The study researchers found that postsurgical costs rose by about 142% for dogs who developed surgical site infections. The increased expense is due primarily to the need for additional follow-up appointments, culture and sensitivity testing, and antibiotic therapy. The study authors concluded that:

"… avoiding surgical infections is vital to preserve the patient's overall health status and to avoid unnecessary expenses. In fact, the implementation of surveillance and control systems for SSIs could reduce the economic costs and improve the service offered to patient and owner."2

Have You Considered Postsurgical Massage for Your Pet?

Some veterinarians are implementing therapeutic massage in their practices to make post-operative patients more comfortable, and to speed recovery time. Writing for Veterinary Practice News, Dr. Narda Robinson encourages her fellow veterinarians to learn to perform bodywork or employ someone in their practice who does:

“Gentle, careful, scientific and evidence-informed massage can work wonders for those patients who accept touch and need help recovering from surgery, trauma or a variety of medical conditions.

Even with animals that don’t at first welcome hands-on healing, many can learn to relax and appreciate massage when it is delivered with care and respect for the patient’s individual physical and emotional receptivity.”3

One of the therapeutic benefits of massage is that it increases the movement of fluids in the body such as water, blood, and lymphatic fluids. Improved circulation helps to flush toxins, which boosts the immune system.

In post-operative pets, massage can help flush the body of sedation and anesthesia drugs as well as stored toxins, which increases the speed at which animals heal. The movement of lymphatic fluids fortifies the immune system, which can also shorten recovery time.

Massage also helps decrease inflammation and pain, can lower blood pressure, restore normal breathing patterns, and help the digestive tract get moving again. And as we all know, massage decreases stress and anxiety.

When a pet undergoes major surgery, he must often be kept immobile during the initial recovery period. When an animal remains very still, bodily fluids accumulate and stagnate. Additionally, during surgery animals are often restrained in unnatural positions so the surgeon has optimal access to the surgical site, but this means their bodies are positioned in ways that can cause muscular tension and discomfort, postsurgically.

Massage, especially long strokes, helps to promote normal fluid flow throughout the body and reduce lactic acid build up in muscles. This speeds up the recovery process, reduces pain, and helps prevent digestive issues like constipation.

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