Optimism warranted when considering colic surgery in foals – study

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Study of case records from five referral hospitals in the United States unearthed encouraging results.
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More optimism is warranted when considering whether to operate on foals for obstructions of the small intestine, researchers report.

Lower survival rates have been reported in foals than adults with severe colic lesions obstructing blood flow to the small intestine, but this has not been compared directly.

“These survival rates are important to horse owners making medical decisions surrounding colic, for both the foal’s wellbeing and the owner’s finances,” Sara Erwin and her fellow researchers noted in the journal Animals.

In a retrospective case-control study, the hospital records of surgical colic cases were collected from five academic referral hospitals in the United States to directly compare foal and adult survival rates following surgery for specific colic lesions.

The study team hypothesized that foals would survive less often than case-matched adults.

Case records involving foals aged six months or younger were assessed, as were adult cases for horses aged between 2 and 20 years.

The data revealed that 24 of 25 foals (that’s 96% of them) and 66 of 75 adults (88%) who recovered from surgery for a suspected small intestinal strangulating obstruction survived to hospital discharge.

The higher short-term survival rate in foals than adults was unexpected, they said, and may have been partly driven by case selection prior to referral or surgery or decision-making during the surgery.

Sixteen, or 39%, of the total of 41 foals included in the study were euthanized during their surgery, whereas 30 of 105 adults – 28.6% – were euthanized during their procedure.

The study was limited by incomplete medical and surgical records, a relatively small sample size, and a lack of long-term follow-up, the researchers said.

However, overall, short-term survival in foals did not significantly differ from adults with comparable colics.

“More optimism toward surgical treatment of foals with suspected small intestinal strangulating obstruction may be warranted,” the authors concluded.

Common lesions in foals that recovered from surgery were volvulus (obstruction due to twisting or knotting of the intestine), which affected 13 of the youngsters, and intussusception (in which part of the intestine telescopes into itself), which affected five of the foals.

In adults, the most common lesions were volvulus (involving 25 cases) and a strangulating lipoma (when a fatty tumor gets wrapped around part of the small intestine), which was the problem found in 23 animals.

The authors, discussing their findings, said long-term follow-up was incomplete in the study, so no conclusions could be drawn regarding foal or adult outcomes beyond discharge from hospital.

“This may be a target for future research, as updated long-term survival statistics would be of similar interest to horse owners and veterinarians,” they said.

In conclusion, they said the results show no significant difference in the short-term outcome of surgically treated foals with suspected small intestinal strangulating obstructions compared with adults.

“First opinion veterinarians should be encouraged to discuss a surgical referral option for owners of foals with suspected small intestinal strangulating obstruction more favorably given these updated short-term survival rates.”

More research is needed in this area, they said. More data and updated representative statistics regarding foal survival for referring veterinarians will allow foal owners to make the most appropriate decision for the foal’s wellbeing and allow for judicious use of the owner’s finances.

Future work might focus on better identifying the factors that influence the decision-making of surgeons and foal owners, they said.

The study team comprised Erwin, Marley Clark, Anthony Blikslager and Amanda Ziegler, all with North Carolina State University; Julie Dechant, with the University of California, Davis; Maia Aitken, with the University of Pennsylvania; and Diana Hassel, with Colorado State University.

Erwin, S.J.; Clark, M.E.; Dechant, J.E.; Aitken, M.R.; Hassel, D.M.; Blikslager, A.T.; Ziegler, A.L. Multi-Institutional Retrospective Case-Control Study Evaluating Clinical Outcomes of Foals with Small Intestinal Strangulating Obstruction: 2000–2020. Animals 2022, 12, 1374. https://doi.org/10.3390/ani12111374

The study, published under a Creative Commons License, can be read here

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