Podcasts

Perioperative outcomes in dogs with hemoabdomen | VETgirl Veterinary CE Podcasts

In today’s VETgirl online veterinary CE podcast, we review a common presenting complaint to emergency veterinarians: hemoabdomen.  Most of us know that the majority of spontaneous hemoperitoneums are due to bleeding splenic masses (malignant or not), and if you’re dealing with a hemangiosarcoma, the long term prognosis isn’t great. But have you thought about what factors might be associated with a worse perioperative outcome (for example, from the time of admission for the bleed through surgery to discharge) in this critically ill, emergent population?

Well, Lux et al out of UC Davis wanted to evaluate this, so in a study called “Perioperative outcome in dogs with hemoperitoneum: 83 cases (2005-2010),” they retrospectively evaluated cases of spontaneous and traumatic hemoperitoneum that went to surgery over a 5 year period.  83 dogs were included during the study period, of which the majority had spontaneous hemoperitoneum (77/83, 92.8%) and the remaining 6 had a history of traumatic hemoperitoneum. The following were the most common clinical signs seen: lethargy (83%), anorexia (40%) and vomiting (14%). 16% of patients also had an episode of acute collapse before clinical evaluation.

Almost 50% of the dogs (40/83) were tachycardic (defined as >140 bpm) and 12% had a heart murmur. Patients that were tachycardic on presentation were significantly less likely to be discharged from the hospital (p=0.049). Age, body weight, body temperature, respiratory rate and systolic arterial blood pressure on presentation were not significantly associated with survival to discharge. None of the clinical laboratory values evaluated including PCV, platelet count, albumin, PT, aPTT and lactate among others, were significantly associated with survival to discharge.

In this study, evidence of pleural effusion (based on thoracic radiographs) was a negative prognostic indicator for discharge (p=0.018). All of the dogs in the study received a blood product transfusion, and 4 patients received massive transfusion. (BTW, a massive transfusion is defined by one of 3 criteria: when a transfusion of whole blood or blood components in volume is a) greater than a patient’s estimated volume within 24 hours, b) half of the patient’s estimated blood volume in 3 hours, or c) 150% of the patient’s blood volume irrespective of time). The need for massive transfusion was also a negative prognostic indicator for discharge (p=0.035).

Of the 77 dogs with spontaneous hemoperitoneum, 67/77 (87%) had neoplasia as the underlying cause, with 76.1% being hemangiosarcoma. This is very similar to previous studies that have been done. Looking at all of the dogs and all sources of bleeding, those with splenic rupture as the underlying cause were significantly more likely to be discharged (p<0.001) (as compared to neoplasia of the liver, etc.). Post-operatively, respiratory disease secondary to suspected pulmonary thromboembolism (PTE) or acute respiratory distress syndrome (ARDS) was negatively associated with discharge (p=0.01).

Overall, a total of 13 (15.7%) dogs died or were euthanized in the perioperative period. Three suffered cardiopulmonary arrest (CPA) and were unable to be resuscitated, 6 were euthanized during surgery due to suspected metastatic disease or uncontrollable hemorrhage, and 4 were euthanized post-op due to complications including suspected PTE, aspiration pneumonia and DIC.

So, what can we take away from this VETgirl podcast now that we’re all depressed?

In this study, dogs with hemoperitoneum were less likely to be discharged from the hospital if they were tachycardic, had bicavitary (abdominal and pleural) effusion, developed respiratory disease due to PTE or ARDS, or required massive blood transfusions. The only good news? Splenic disease as the underlying cause of the bleeding was positively associated with discharge. This may be because splenectomy is generally less complicated than surgery of other abdominal organs like the liver, kidneys, etc.

There are  few limitations of this study. First, this is a small retrospective study and since only a few animals did not survive to discharge, it is difficult to evaluate the true significance of these prognostic findings. That said, even though this study is small, the information provided might be helpful to clients making difficult decisions about treating their pet with hemoperitoneum and possible contributing factors to outcome.

So, in conclusion, in dogs with hemoabdomens, perioperative risk factors that may worsen outcome include tachycardia on presentation, the need for massive transfusion, bicavitary effusion and development of severe respiratory disease (PTE, ARDS) post-operatively. These may be important factors to talk with your owners about when discussing prognosis. If the disease is confined to the spleen, however, survival to discharge is more likely!

References:

  1. Lux CN, Culp WT, Mayhew PD et al. Perioperative outcome in dogs with hemoperitoneum: 83 cases (2005-2010). JAVMA 2013;242:1385-1391.

Abbreviations:

aPTT: partial thromboplastin time

ARDS: acute respiratory distress syndrome

bpm: beats per minute

CPA: cardiopulmonary arrest

DIC: disseminated intravascular coagulation

PCV: packed cell volume

PT: prothrombin time

PTE: pulmonary thromboembolism

 

Only VETgirl members can leave comments. Sign In or Join VETgirl now!