Читать книгу Small Animal Surgical Emergencies - Группа авторов - Страница 237

Dogs managed appropriately for GDV have a good prognosis with the majority of dogs surviving. Published surgical survival rates for GDV are variable. In the three largest studies (306–382 dogs) in the past 10 years from referral practice, the survival rate was 83.5–90.2% [7, 11, 12]. Survival rate is similar but possibly lower in first‐opinion practice, with 79.3–81.7% of surgically treated dogs surviving to discharge [2, 12]. It is worth remembering that a proportion of dogs are euthanized prior to surgery, presumably due to cost limitations, comorbidity, or perceived poor prognosis. The proportion of dogs that die or are euthanized prior to surgery has been reported as 23.3% in academic referral practice in North America, 37.4% in first‐opinion emergency practice in the UK, and 37.5% in a mixed population of first‐opinion emergency practice and private referral practice in Australia [2, 11, 12]. Younger dogs and those ambulatory at presentation were significantly more likely to have surgical management, suggesting that these factors may be linked to the decision to perform euthanasia.

As mentioned earlier, several studies have found significantly increased mortality rates for dogs with gastric necrosis and for those treated with gastric resection and splenectomy. This is perhaps unsurprising and likely reflects the severity of disease in these individuals and the potential technical challenge of gastric resection in particular. It is worth remembering that a proportion of dogs with gastric necrosis are euthanized perioperatively due to the severity of their disease and the perceived poor prognosis.

A great deal of discussion has taken place over the association with lactate and mortality [13, 14, 28–31 50]. As the findings of these studies are somewhat contradictory at this stage, lactate should not be relied on as a sole marker for prognosis [13, 14,28–31, 50]. Other factors associated with a poor prognosis include the presence of pre‐ and postoperative cardiac arrhythmias, having a splenectomy with or without gastric resection [7], and the occurrence of acute kidney injury, DIC, or sepsis [9, 25]. Few factors have been associated with decreased mortality other than time from presentation to surgery, with increased time associated with reduced mortality [7]. If an appropriate gastropexy is performed, recurrence rate is low [51].