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):

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 20177 0 0 0 +

0  short and medium term

++ long term

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

Not assessable


Not assessable


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


  1. Turk R, Singh A, Weese JS. Prospective surgical site infection surveillance in dogs.Vet Surg2015;44:2-8.
  2. Weese JS, Halling KB. Perioperative administration of antimicrobials associated with elective surgery for cranial cruciate ligament rupture in dogs: 83 cases (2003-2005). JAVMA2006;229:92-95.
  3. Vasseur PB, Paul HA, Enos LR, Hirsch DC. Infection rates in clean surgical procedures: a comparison of ampicillin prophylaxis vs a placebo. JAVMA1985;187:825-827.
  4. Mayhew PD, Freeman L, Kwan T, Brown DC. Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007-2008). JAVMA2012;240:193-198.
  5. Eugster S, Schawalder P, Gaschen F, Boerlin P. A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg2004;33:542-550.
  6. Nicholson M, Beal M, Shofer F, Brown DC. Epidemiologic Evaluation of Postoperative Wound Infection in Clean-Contaminated Wounds: A Retrospective Study of 239 Dogs and Cats. Veterinary Surgery2002;31:577-581.
  7. Aiken MJ, Hughes TK, Abercromby RH, Holmes MA, Anderson AA. Prospective, Randomized Comparison of the Effect of Two Antimicrobial Regimes on Surgical Site Infection Rate in Dogs Undergoing Orthopedic Implant Surgery. Vet Surg2015;44:661-667.
  8. Bowersock TL, Wu CC, Inskeep GA, Chester ST. Prevention of bacteremia in dogs undergoing dental scaling by prior administration of oral clindamycin or chlorhexidine oral rinse. J Vet Dent2000;17:11-16.
  9. Nieves MA, Hartwig P, Kinyon JM, Riedesel DH. Bacterial isolates from plaque and from blood during and after routine dental procedures in dogs. Vet Surg1997;26:26-32.
  10. Gonzalez OJ, Renberg WC, Roush JK, KuKanich B, Warner M. Pharmacokinetics of cefazolin for prophylactic administration to dogs. Am J Vet Res2017;78:695-701.
  11. Marcellin-Little DJ, Papich MG, Richardson DC, DeYoung DJ. Pharmacokinetic model for cefazolin distribution during total hip arthroplasty in dogs. Am J Vet Res1996;57:720-723.
  12. Bergstrom A, Dimopoulou M, Eldh M. Reduction of Surgical Complications in Dogs and Cats by the Use of a Surgical Safety Checklist. Vet Surg2016;45:571-576.
  13. Yap FW, Calvo I, Smith KD, Parkin T. Perioperative risk factors for surgical site infection in tibial tuberosity advancement: 224 stifles. Vet Comp Orthop Traumatol2015;28:199-206.
  14. Stauffer KD, Tuttle TA, Elkins AD, Wehrenberg AP, Character BJ. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). J Am Anim Hosp Assoc2006;42:44-50.
  15. Cook JL, Luther JK, Beetem J, Karnes J, Cook CR. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg2010;39:315-323.
  16. Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg2010;39:460-474.
  17. Gatineau M, Dupuis J, Plante J, Moreau M. Retrospective study of 476 tibial plateau levelling osteotomy procedures. Rate of subsequent ‘pivot shift’, meniscal tear and other complications. Vet Comp Orthop Traumatol2011;24:333-341.
  18. Pacchiana PD, Morris E, Gillings SL, Jessen CR, Lipowitz AJ. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc2003;222:184-193.
  19. Frey TN, Hoelzler MG, Scavelli TD, Fulcher RP, Bastian RP. Risk factors for surgical site infection-inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005-2006). J Am Vet Med Assoc2010;236:88-94.
  20. Pollari FL, Bonnett BN. Evaluation of postoperative complications following elective surgeries of dogs and cats at private practices using computer records. Canadian veterinary journal1996;37:672-678.
  21. Dorn AS, Swist RA. Complications of Canine Ovariohysterectomy. Journal of the American Animal Hospital Association1977;13:720-724.
  22. Vasseur PB, Levy J, Dowd E, Eliot J. Surgical wound infection rates in dogs and cats. Data from a teaching hospital.Vet Surg1988;17:60-64.
  23. Casale SA, McCarthy RJ. Complications associated with lateral fabellotibial suture surgery for cranial cruciate ligament injury in dogs: 363 cases (1997-2005). JAVMA2009;234:229-235.
  24. Heldmann E, Cimino Brown D, Shofer F. The assocation of propofol usage with postoperative wound infection rate in clean wounds: A retrospective study. Veterinary Surgery1999;28:256-259.
  25. Billings L, Vasseur PB, Fancher C, Miller M, Nearenberg D. Wound infection rates in dogs and cats after use of cotton muslin or disposable impermeable fabric as barrier material: 720 cases (1983-1989). JAVMA1990;197:889-892.
  26. Beever L, Giles K, Meeson R. Postoperative complications associated with external skeletal fixators in cats. J Feline Med Surg2017;19:727-736.
  27. Andrade N, Schmiedt CW, Cornell K et al. Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery. Vet Surg2016;45:214-222.
  28. Beal MW, Brown DC, Shofer F. The effects of perioperative hypothermia and the duration of anaesthesia on postoperative wound infection rate in clean wounds: a retrospective study. Veterinary Surgery2000;29:123-127.
  29. Bristow PC, Meeson RL, Thorne RM et al. Clinical comparison of the hybrid dynamic compression plate and the castless plate for pancarpal arthrodesis in 219 dogs. Vet Surg2015;44:70-77.
  30. Jardel N, Hidalgo A, Leperlier D et al. One stage functional end-to-end stapled intestinal anastomosis and resection performed by nonexpert surgeons for the treatment of small intestinal obstruction in 30 dogs. Vet Surg2011;40:216-222.
  31. Nazarali A, Singh A, Weese JS. Perioperative administration of antimicrobials during tibial plateau leveling osteotomy. Vet Surg2014;43:966-971.
  32. Nicoll C, Singh A, Weese JS. Economic impact of tibial plateau leveling osteotomy surgical site infection in dogs. Vet Surg2014;43:899-902.
  33. Pratesi A, Moores AP, Downes C, Grierson J, Maddox TW. Efficacy of Postoperative Antimicrobial Use for Clean Orthopedic Implant Surgery in Dogs: A Prospective Randomized Study in 100 Consecutive Cases. Vet Surg2015;44:653-660.
  34. Solano MA, Danielski A, Kovach K, Fitzpatrick N, Farrell M. Locking plate and screw fixation after tibial plateau leveling osteotomy reduces postoperative infection rate in dogs over 50 kg. Vet Surg2015;44:59-64.
  35. Sterne JA, Hernan MA, Reeves BC et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.BMJ2016;355:i4919.

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