The evidence – surgery guidelines

These guidelines are designed to be evidence based and transparent. As such, we’ve provided the evidence behind our recommendations.

 

A literature search was undertaken in PubMed using the following search terms:

(Dog OR Cat OR Canine OR Feline) AND Surg* AND (Antibiotic OR Antimicrobial OR Infection OR Complication)

Only research papers pertaining to species other than humans, with abstracts, and papers written in English were considered. No time limit was included.

In addition, guidelines from other professional organisations (restricted to those written in English) were reviewed and in particular, the reference lists of these guidelines. Only evidence-based recommendations were considered in constructing these guidelines. The guidelines were created by consensus by the development group.

 

The abstracts for all returned articles were examined. Articles were included if the title or abstract suggested that either surgical site infection or antimicrobial prophylaxis for surgery were discussed in the paper. In addition, articles were excluded if the sample size was insufficient to make appropriate inferences from the study. All study designs were considered as the literature is limited.

Research assessing risk of surgical site infection (SSI):

RESEARCH SETTING SSI TYPE OF SURGERY COMMENTS
Private practice, Canada19 1-4% OVH & castration
University practice20 12.70% OVH
University practice21 2.50% Elective
University practice2 3.60% CCL
University practice22 3.90% CCL Perioperative antimicrobials did not influence rate although only small number that didn’t get antimicrobials
University practice4 1.70% Minimally invasive
University practice4 5.50% Open surgery Perioperative antimicrobials did not influence rate
University practice21 2.50% Clean
University practice21 4.50% Clean-contaminated
University practice21 5.80% Contaminated
University practice21 18.10% Dirty
University practice23 4.50% Clean
University practice3 0.80% Clean
University practice24 3.50% Elective joint surgery
University practice25 9.0% External fixation in cats

 

OVH, ovariohysterectomy; CCL, cranial cruciate ligament syndrome

Quality of the evidence (Risk of Bias assessment):

  Domains Reason for non-inclusion
  Confounding Selection bias Classification bias Deviation from intended intervention Missing data Measurement Reporting  
Aiken et.al. 20177 0 0 0 +

0  short and medium term

++ long term

0 0
Andrade et.al. 201626 +++ + 0 N/A 0 0 0 Risk of confounding too high
Beal et.al., 200027 + + 0 NR 0 + 0
Beever et.al., 201725 + 0 0 N/A + + 0
Bergstrom et.al., 201611 + + 0 0 Not assessable + 0
Billings et.al., 199024 +++ ++ 0 0 Not assessable Not assessable N/A Risk of confounding too high
Bristow et.al., 201528 ++ + 0 NR

Not assessable

 

Not assessable

 

N/A Did not report length of antimicrobial therapy
Bowersock et.al., 20008 0 0 0 0 0 0 +
Casale & McCarthy, 200922 + ++ 0 N/A NR + N/A
Cook et.al., 201014 + + 0 0 Not assessable Not assessable 0
Eugster et.al., 20045 0 0 0 N/A + + 0
Fitzpatrick & Solano, 201015 +++ + 0 0 Not assessable + 0 Pre-operative antimicrobial therapy not given early enough
Frey et.al., 201018 + ++ 0 0 Not assessable Not assessable N/A Did not report length of antimicrobial therapy
Gatineau et.al., 201116 +++ +++ 0 N/A Not assessable Not assessable 0 Did not report timing of antimicrobial therapy, post-operative therapy given at the surgeon’s discretion
Heldmann et.al., 199923 ++ +++ 0 0 Not assessable Not assessable N/A Did not describe antimicrobial therapy
Jardel et.al., 201129 +++ +++ 0 0 Not assessable Not assessable N/A High risk of confounding and selection bias
Nazarali et.al., 201430 ++ +++ 0 N/A NR 0 ++ High risk of confounding, selection and reporting bias
Mayhew et.al., 20124 ++ ++ 0 N/A + 0 N/A
Nicoll et.al., 201431 0 0 0 N/A 0 0 N/A
Nicholson et.al., 20026 ++ ++ 0 N/A NR 0 +++ Limited data in paper to verify results. No reporting on effect of antimicrobials
Nieves et.al., 19979 0 0 0 N/A 0 0 +
Pacchiana et.al., 200317 +++ + 0 N/A Not assessable Not assessable 0 Antimicrobial therapy given at the discretion of surgeon and not included as exposures variable
Pratesi et.al., 201532 0 0 0 + 0 0 +++
Pollari & Bonnett, 199618 0 + + N/A 0 + 0
Solano et.al., 201533 +++ +++ 0 NR NR 0 + Confounding and selection bias too high
Stauffer et.al., 200613 0 + 0 N/A NR 0 N/A
Turk et.al., 20151 0 0 ++ N/A NR ++ 0
Vasseur et.al., 19853 0 0 0 NR N/A 0 0
Vasseur et.al., 198821 ++ 0 + N/A NR + N/A
Weese & Halling, 20062 + + 0 N/A Not assessable 0 N/A
Yap et.al., 201512 + + 0 N/A Not assessable Not assessable 0

Risk of bias was assessed using the ROBINS-I assessment tool28.

NR, not reported; N/A, not applicable

Manuscripts in red were not considered for recommendations.

Range 0 (no bias detected) to +++ (major bias detected)

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