Prognosis for colic in geriatric horses - DVM
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Prognosis for colic in geriatric horses
Age alone does not dictate survival rates, studies show


DVM360 MAGAZINE


Older horses more likely to need surgery

Older horses were more likely to require surgery than younger horses, based on the data from New Bolton Center. Geriatric horses were one-and-a-half times more likely to undergo surgery and three times more likely to be subjected to euthanasia after medical management compared with mature horses. The higher occurrence of strangulating lesions (particularly small intestinal strangulating lesions), combined with their tendency toward less dramatic signs of colic, should be taken into consideration when evaluating these patients, to avoid any treatment delay.

"Given that older horses may be more critically ill, and may be more likely to require surgery, referring them sooner may reduce the number we have to euthanize during surgery because we waited too long," Perrier says.

Southwood suggests owners and veterinarians keep in mind that older horses showing signs of colic could have a strangulating lesion. "When I have an older horse, one in its late teens or older, come into the hospital, I initially presume it has a strangulating lesion, and I approach it by proving to myself the horse does not have a strangulating lesion," Southwood says. "The diagnosis is based on the signs of pain, history, physical exam, laboratory data, palpation per rectum, abdominal ultrasonographic examination, nasogastric reflux and peritoneal fluid analysis."

If she proves to herself the horse doesn't have a strangulating lesion, then she treats it medically. The goal, she says, is to get these horses to surgery as soon as possible to optimize the chance of having a favorable outcome. "Sometimes we can get them early enough that we don't have to resect the bowel," she says. "The flip side is we don't want to take horses to surgery unnecessarily, and that's where carefully assessing the clinical findings is important, but it's often challenging."

Euthanasia?

Looking at short-term survival of emergency admissions, the main reason geriatric horses had a lower survival rate compared with mature horses is likely because owners elect euthanasia without surgery. This decision may be due to poor prognosis for survival based on physical examination and laboratory data at admission, perceived poor prognosis based on age or the unwillingness of an owner to make a financial investment in an aged horse. Geriatric horses, even those in their late teens and early 20s, requiring surgery for a strangulating lesion do not have a less-favorable prognosis for survival compared with mature horses. Therefore, a poor prognosis based on age alone, or election of euthanasia based on age alone, is inappropriate.

"Now when I'm talking to an owner, I feel I can give him or her as much accurate information as possible and advise that he or she does not necessarily need to euthanize the horse just because it's 24 years old," says Southwood. She notes that euthanasia still may be indicated if an owner can't afford surgery or if the horse has other serious underlying disorders.

The take-home message

The study concluded that if you look at the overall population of horses with colic, both geriatric and nongeriatric, the geriatric horses do have an overall lower survival rate, but that includes those euthanized without surgery and those euthanized during surgery.

From the total population, if you take out the number of horses euthanized before or during surgery, there was no difference in the survival of the geriatric and nongeriatric mature horses, and that included horses more than 20 years of age. "When we looked at the ones with small intestinal lesions where the owners decided to go on with surgical repair, we did not see a difference in survival," Southwood says.

Southwood recently did colic surgery on a 32-year-old horse. "He had a strangulating lipoma, and we removed about 12 feet of small intestine. The horse had no complications after surgery. He never missed a beat," says Southwood. "He is currently at home doing well."

The take-home message: "Early referral and surgical intervention, when necessary, is really important," says Southwood. "These older horses, especially those with small intestinal lesions, can do very well with surgery."

Kane is a researcher and consultant in animal nutrition. He is an author and editor on nutrition, physiology and veterinary medicine with a background in horses, pets and livestock. He is based in Seattle.

REFERENCES

1. Mair TS, Smith LJ. Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 1: Short-term survival following a single laparotomy. Equine Vet J 2005;37(4):296-302.

2. Southwood LL, Gassert T, Lindborg S. Colic in geriatric compared to mature nongeriatric horses. Part 1: Retrospective review of clinical and laboratory data. Equine Vet J 2010;42(7):621-627.

3. Southwood LL, Gassert T, Lindborg S. Colic in geriatric compared to mature nongeriatric horses. Part 2: Treatment, diagnosis and short-term survival. Equine Vet J 2010;42(7):628-635.

4. Krista KM, Kuebelbeck KL. Comparison of survival rates for geriatric horses versus nongeriatric horses following exploratory celiotomy for colic. J Am Vet Med Assoc 2009;235(9):1069-1072.


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Source: DVM360 MAGAZINE,
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