outpatient arthroscopy for horses

Outpatient surgeries are common in human medicine. Cataract surgery, small joint repairs, and carpal tunnel treatment are just a few of the procedures that generally no longer require an overnight stay. In equine medicine, however, outpatient surgeries aren’t as common. There’s been little safety data available on performing procedures, such as arthroscopy—a minimally invasive procedure in which a vet examines and, if needed, treats joint damage using a small endoscope—on an outpatient basis. But, new study results on outpatient arthroscopy for horses are helping fill that void.

Erica Secor, DVM, MS, Dipl. ACVS, currently a surgeon at the Wisconsin Equine Clinic and Hospital, in Oconomowoc, and colleagues recently confirmed that outpatient elective arthroscopy can be performed safely without a higher risk of complications than inpatient procedures.

“The original goal of the study and most important takeaway was that performing elective arthroscopic surgery on an outpatient basis did not result in an increased risk of complications,” she said.

One of the most clinically significant complications of arthroscopic surgery is septic arthritis, or joint infection. In Secor’s study of 357 horses that underwent 366 elective arthroscopic procedures, the overall septic arthritis rate was 0.47%, which compares favorably with previously reported rates, she said. The team found no association between patients’ hospitalization status—inpatient (198 procedures) or outpatient (168 procedures)—and septic arthritis development rate.

The team also evaluated the horses’ postoperative fever incidence. They identified fever in 9% of the inpatient population (14 of 147 horses) and none of the outpatient horses; Secor noted this could be due to owner reporting bias. She also said most horses with fevers did not require treatment or develop other clinical signs, and fever resolved within 24 hours

“The mild, transient fever seen in these horses may be due to surgical inflammation and is useful information when monitoring these patients postoperatively,” she said.

Outpatient horses also had no reported incidences of colic or diarrhea. Again, she said, this was likely due to bias associated with the follow-up phone interviews; however, hospital-acquired infections, feed and housing changes, medications, and hospitalization stress could all potentially predispose hospitalized patients to gastrointestinal problems.

“We may find that there are times we are doing a disservice to our patients for hospitalizing them longer than is necessary, but additional work would be required to determine if that is the case,” Secor said.

Young, healthy horses with simple lesions are often good candidates for outpatient arthroscopic surgery, she said.

However, “there are absolutely cases that I do not recommend outpatient arthroscopy on,” she said, such as horses with additional health issues, those needing pain medication, or longer surgery and anesthesia times.

The follow-up care available at home plays a big role in the decision to perform an inpatient or outpatient surgery, Secor said. Veterinarians must trust that owners and trainers can identify and respond to problems in the postoperative period.

“Many patient, client, and clinician factors need to be considered when determining the ideal treatment plan for a given case,” she said.

The study, “Comparison of complication rates following elective arthroscopy performed as inpatient versus outpatient surgery in horses,” was published in the Journal of the American Veterinary Medical Association.