Application of a framework to mitigate the risk of surgical site infection after exploratory celiotomy in horses: A retrospective study.

Abstract

OBJECTIVE: To describe the methodology used to identify the contributors to a perceived sudden increase in exploratory celiotomy surgical site infections (SSI) and complications at the North Carolina State University Veterinary Teaching Hospital (NCSU VTH) between 2019 and 2020 and evaluate the effect of the designed intervention up to 4&#x2009;years after its implementation. STUDY DESIGN: Case-control retrospective study over a five-year period. ANIMALS: A total of 448 horses that underwent exploratory celiotomy for the treatment of acute abdominal pain were included. METHODS: Medical records of horses that underwent exploratory celiotomy between 2019-2024 were reviewed from software systems used at the NCSU VTH. A surgical audit was conducted to assess adherence to best practices and identify factors contributing to increased SSI incidence. This led to the development of an evidence-based intervention to address procedural deficiencies and incorporate preventative perioperative strategies. The approach, resultant protocols, and reduction of SSI incidence are described. Data were analyzed using Fisher's exact test and univariate logistic regression. Statistical significance was set to p&#x2009;<&#x2009;.05. RESULTS: A significant increase in %SSI was observed from 7.7% in 2019 to 29% in 2020 (p&#x2009;=&#x2009;.0067). Following new protocol implementation, %SSI decreased to 2.3%. CONCLUSION: A surgical audit enabled the development of an evidence-based intervention that significantly reduced SSI incidence after exploratory celiotomy surgery. CLINICAL SIGNIFICANCE: Surgical audits serve as critical quality-of-care measure, allowing hospitals to identify procedural deficiencies. There is currently no literature that describes structured processes to manage this kind of problem in veterinary medicine. Surgical audit implementation may help other hospitals faced with similar challenges.