Prognosis & Risks of Large Intestinal Surgery in Cats

In the literature

Lux CN, Roberts S, Grimes JA, et al. Evaluation of short-term risk factors associated with dehiscence and death following full-thickness incisions of the large intestine in cats: 84 cases (1993-2015). J Am Vet Med Assoc. 2021;259(2):162-171.

The Research …

Dehiscence is a critical surgical complication. Large intestinal incisions may be prone to dehiscence due to poor collateral blood supply, high bacterial load, and high intraluminal pressure during fecal bolus passage.<sup1 sup> 

This retrospective study evaluated 84 cats that underwent full-thickness incisions of the large intestine during various procedures, including subtotal colectomy with preservation of the ileocolic junction and colorectal anastomosis, total colectomy (including the ileocolic junction and enterorectal anastomosis), partial colectomy with colocolic anastomosis, partial colectomy with ileocolic resection and jejunocolic anastomosis, partial colectomy with ileocolic resection and ileocolic anastomosis, and colonic biopsy or colotomy. Reasons for colonic biopsy included chronic vomiting, diarrhea, recurrent colitis with rectal prolapse, and hematochezia.   

Factors associated with dehiscence included hypoalbuminemia, renal dysfunction, administration of blood products or >2 classes of antimicrobials, and intra-abdominal fecal contamination. Anorexia was the only clinical sign associated with intestinal dehiscence. 

Factors identified as predictors of dehiscence and nonsurvival to hospital discharge included the presence of band neutrophils, administration of blood products, partial colectomy with colonic resection and anastomosis, postoperative inflammation or infection of the skin incision, and postoperative cardiopulmonary arrest. 

Factors associated with nonsurvival to hospital discharge only included low serum globulin concentration, repair of colonic trauma or dehiscence, and postoperative colonic dehiscence.

Complications were uncommon in cats undergoing surgery due to megacolon. No association was found between histologic diagnosis of malignancy or inflammation and survival to discharge or intestinal dehiscence. 

These findings suggest that cats with systemic disease may be at increased risk for postoperative dehiscence compared with cats with focal disease.

… The Takeaways

Key pearls to put into practice:

• Identifying feline patients as low risk for colonic surgery may improve surgical outcome. Stabilization, diagnosis, and preoperative treatment of cats at higher risk may also improve the outcome.

• Referral to a board-certified surgeon is likely to improve survival. This study only evaluated cases treated by board-certified surgeons from tertiary institutions, which may have better resources and more consistent overnight care.

• Pet owners should understand colonic surgery is a last resort because of the inherent risks of surgery on an organ with a high bacterial load, different vasculature, and intermittently high intraluminal pressure. Surgery can, however, be an appropriate alternative to failed medical management in some cases.