@article{davis_hardie_martin_zhu_brownie_2007, title={Correlation between perioperative factors and successful outcome in fibrosarcoma resection in cats}, volume={161}, ISSN={["0042-4900"]}, DOI={10.1136/vr.161.6.199}, abstractNote={FELINE fibrosarcoma (FSA) is one of the most common subcutaneous neoplasms in cats. Typically, FSA is a locally aggressive tumour, with a moderate metastatic rate of 11 to 22·5 per cent (Brown and others 1978, Cronin and others 1998, Hershey and others 2000, Cohen and others 2001, Kobayashi and others 2002) and recurrence rates as high as 67 per cent (Davidson and others 1997). Aggressive surgical excision and radiation therapy are the recommended treatments for FSA (Davidson and others 1997, Cronin and others 1998, Hershey and others 2000, Kobayashi and others 2002). Despite advances that have improved long-term outcomes, little research has been conducted to address the effects of various forms of perioperative support on acute morbidity and mortality. The purpose of this short communication was to identify perioperative factors affecting immediate surgical outcome in cats undergoing wide or radical en bloc reconstructive surgery for fibrosarcoma. This retrospective study evaluated 153 cats with histologically confirmed fibrosarcoma that were presented to the North Carolina State University Veterinary Teaching Hospital between October 1990 and November 2004. Inclusion criteria were a histological diagnosis of FSA and en bloc surgical resection of the mass. Success was defined as the absence of perioperative complications or death. Fisher’s exact test was used for qualitative variables. Unconditional logistic regression was used to evaluate the potential effects of qualitative clinical variables on the success of surgery. Success was recorded in 123 cats (80·4 per cent). Twentyfour cats (15·7 per cent) experienced non-fatal complications identified as causes of postoperative morbidity: 24 had wound complications, two had pain, one had hypovolaemic shock with central nervous system ischaemia and one had acute renal failure. Four cats had multiple complications. Seroma was the most common wound complication (10 cats), followed by dehiscence in six, infection in five and subcutaneous emphysema in two. Seven cats (4·6 per cent) died: two as a result of cardiac arrest, two of peritonitis, two of pancreatitis and one because of haemolysis. The median age of all the cats was eight years. Forty-eight cats (31·4 per cent) had coexistent non-neoplastic disease. No vital parameters (age, sex, breed, temperature, heart rate, respiratory rate, packed-cell volume, total protein, blood urea nitrogen and glucose) were significantly correlated with success. In total, 127 cats (83 per cent) had a previously resected fibrosarcoma. The tumours were found at various sites: 58 were intrascapular, 31 were in a limb, 25 were in a flank, 21 were paraspinal, 15 were in the chest, two were in both the intrascapular and scapular regions and one was in the head. Previous resection and tumour location were not significantly correlated with success. Fourteen cats did not receive any preoperative neoadjunctive treatment. All neoadjunctive therapy was administered before surgery. Of those that did receive neoadjunctive therapy, 73 received radiation alone, 55 had radiation combined with chemotherapy and 11 had chemotherapy alone. No variables associated with neoadjunctive therapy were significantly correlated with success. The mean length of surgery was 106·5 minutes. Length of surgery was the only surgical factor that was significantly correlated with increased wound complications (P<0·005). Length of surgery was also positively correlated with length of hospitalisation, with longer surgeries resulting in longer hospitalisations (P<0·005). Most cats (81) received two types of analgesic perioperatively, while 41 cats received three types of analgesic. Narcotics were the most common analgesics administered (in 149 cats), followed by ketamine in 111, local anaesthetics in 43, nonsteroidal anti-inflammatory drugs in 42 and α2-adrenoceptor agonists in 20. Local analgesic wound infusion catheters were used in 19 cases. Using a wound infusion catheter significantly decreased the length of hospitalisation (P=0·039). The choice of analgesics and the numbers of analgesics administered (multimodality) did not correlate with success. The mean length of time to eating after surgery was 28·6 hours. The mean length of hospitalisation was 3·2 days. One large epidemiological veterinary study demonstrated a significant risk of postoperative wound infection with prolonged surgical and anaesthetic times (Nicholson and others 2002). Animals undergoing a 90-minute surgical procedure are twice as likely to develop wound infections as animals undergoing a 60-minute procedure (Brown and others 1997). Cats in the present study had a mean operative time of 106·5 minutes, which would have predisposed them to developing wound complications. Longer surgery was also correlated with a longer duration of hospitalisation. However, longer surgery time is an indicator of the complexity of the resection. In such cases, longer hospitalisation may have been due to a prolonged need for analgesia or more time required to manage wound complications. Cats receiving local analgesics infused through wound catheters (Wolfe and Muir 2003) spent significantly less time in hospital than those that did not, suggesting that the cats became mobile more quickly and took less time to start eating than those on other analgesic regimens. Further investigation is needed to evaluate this potentially beneficial effect in cats. In conclusion, wound complications and longer hospitalisation periods were most frequent in cats that underwent prolonged surgery. Using a wound infusion catheter significantly decreased the length of hospitalisation.}, number={6}, journal={VETERINARY RECORD}, author={Davis, K. M. and Hardie, E. M. and Martin, F. R. and Zhu, J. and Brownie, C.}, year={2007}, month={Aug}, pages={199–200} }