Nicole J. Buote

Objective: Evaluate antimicrobial susceptibility patterns among bacterial pathogens isolated from canine pyometra cases and generate a cumulative antibiogram to inform evidence-based treatment recommendations. Methods: This observational retrospective study included canine uterine samples submitted for antimicrobial susceptibility testing to Idexx Laboratories and the Cornell University Animal Health Diagnostic Center between 2007 and 2023 in the US. Susceptibility results were interpreted according to current Clinical and Laboratory Standards Institute criteria. Cumulative antibiograms were generated with an interactive app for analysis of diagnostic antimicrobial susceptibility test data (AMR Visualizer; RShiny). Results: Across the 2 laboratories, 6,462 bacterial isolates were included. Escherichia coli was the predominant pathogen (71.7%). Among E coli isolates, poor susceptibility was observed to penicillins, β-lactam/β-lactamase inhibitor combinations, tetracyclines, and chloramphenicol. Excellent susceptibility was maintained to aminoglycosides, third-generation cephalosporins, potentiated sulfonamides, and imipenem. Most E coli isolates were susceptible-dose-dependent to fluoroquinolones and susceptible with increased exposure to intravenous amoxicillin–clavulanic acid. Conclusions: Most canine pyometras are caused by E coli . The in vitro antimicrobial susceptibility patterns of these isolates contribute to understanding resistance trends and support antimicrobial stewardship efforts. Susceptibility should be interpreted in the context of regimens used for breakpoint development. Clinical Relevance: When perioperative antimicrobial therapy of pyometras is appropriate, veterinarians can use antibiograms to assist in selecting an effective and appropriate antimicrobial before susceptibility test results are available. These antibiograms suggest that folate-pathway inhibitors could be effective empiric choices that align with antimicrobial stewardship principles. High-exposure intravenous amoxicillin–clavulanic acid could be an effective choice in regions where the product is available.

Objective: To identify variables associated with prolonged hospitalization or nonsurvival in the surgical management of pyometra in dogs and to report uterine bacterial susceptibility in comparison with empirically prescribed antibiotics. Methods: Retrospective study of dogs that underwent ovariohysterectomy for management of pyometra at 8 tertiary referral centers between December 1, 2008, and December 31, 2023. Data collected included signalment, preoperative/operative data, antibiotic utilization, and clinical follow-up. Results: 625 dogs met inclusion criteria. Forty dogs (6.4%) experienced major short-term complications, and 604 dogs (96.6%) survived to discharge. Elevated preoperative creatinine concentration and sepsis increased the risk of nonsurvival. Survival to discharge did not differ between nonseptic dogs that received pre- or intraoperative antibiotics and those that did not. Sepsis, elevated creatinine, and interaction between elevated creatinine and altered mentation increased hospitalization duration. At least 1 inappropriate outpatient antibiotic was prescribed in 34.4% (116 of 337) of cases; most dogs that received inappropriate antibiotics were empirically prescribed amoxicillin–clavulanic acid (102 of 116 [87.9%]). Conclusions: Surgical management of pyometra in the tertiary referral setting had a good prognosis regardless of prescribed antibiotic bacterial susceptibility. Elevated creatinine and/or sepsis increased risk of mortality and prolonged hospitalization. The use of pre- and intraoperative antibiotics in nonseptic dogs was not associated with outcome. Clinical Relevance: There was no clear clinical benefit of antibiotic use in the surgical management of pyometra in nonseptic dogs. If empiric antibiotics are indicated, the bacterial susceptibility profile of this patient population suggests a high likelihood of resistance to amoxicillin–clavulanic acid.

Objective: To report on placement and perioperative outcomes associated with one-lung ventilation (OLV) devices utilized in dogs undergoing thoracoscopic surgery. Methods: This multi-institutional retrospective study included dogs undergoing OLV for elective thoracoscopic surgery between January 2013 and December 2023. Patient data, OLV technique, surgical and anesthetic complications, and perioperative blood gases were recorded. Success of OLV was defined as sustained collapse of the intended lung. Complications were graded from 1 (mild) to 5 (death or euthanasia). Results: 93 dogs (47 female, 46 male) were included. The median age was 9.5 years (range, 0.08 to 14.7 years) and median weight was 26.8 kg (range, 2.5 to 62.8 kg). Devices used for OLV included endobronchial blockers (n = 71), double-lumen tubes (15), selective intubation with an endotracheal tube (1), or unspecified (6). One-lung ventilation was successful in 90 dogs. Conversion to an open approach occurred in 23 cases and was secondary to complications of OLV in 4 cases. Grade 2 (moderate) and 3 (severe) hypercapnia were recorded in 62 of 93 dogs and 11 of 93 dogs, respectively. Grade 2 and 3 hypoxemia were recorded in 10 of 93 dogs and 6 of 93 dogs, respectively. Dogs with left bronchus blockade had significantly lower odds of grade 2 hypoxemia compared to dogs with right bronchus blockade. Conclusions: OLV was successful in most cases. Intraoperative hypercapnia and hypoxemia were commonly reported, but rarely led to conversion and typically resolved postoperatively. Clinical Relevance: OLV is a well-tolerated technique in dogs undergoing thoracoscopic procedures with excellent short-term outcomes.

Objective: To quantify the financial impact of surgical site infections (SSIs) following clean-contaminated abdominal surgery in dogs, as well as to evaluate perioperative risk factors in this patient population. Methods: This case-control retrospective study evaluated canine patients undergoing gastrointestinal or urogenital clean-contaminated surgery at a university hospital (2021 to 2024) that either developed an SSI (case) or did not develop an SSI (control). Surgical site infection–positive cases were identified via available records and matched 1:2 with SSI-negative controls by procedure, age, sex, and weight. Economic data and perioperative variables were compared with Wilcoxon rank-sum tests and univariable logistic regression. Results: 63 dogs were included (21 SSI-positive, 42 controls). While initial surgical costs were equivalent, median total treatment costs were 24.1% higher in SSI cases than in matched controls. Intraoperative administration of antihypotensive medication was identified with greater frequency in cases compared to controls (OR, 4.68; 95% CI, 1.48 to 14.79), with glycopyrrolate identified as a specific risk factor (OR, 9.65; 95% CI, 1.00 to 92.73). No additional associations were identified. Conclusions: SSIs substantially increased total treatment costs in dogs undergoing clean-contaminated abdominal surgery, primarily driven by the intensity of intervention. Intraoperative vasopressor use, particularly glycopyrrolate, was identified with greater frequency in cases compared to controls. Clinical Relevance: Reducing SSI rates is essential to minimizing client financial burden. When clinically appropriate, prioritizing medical management for superficial infections offers substantial cost savings over surgical intervention. Judicious use of specific intraoperative antihypotensives may represent a modifiable risk factor for reducing infection rates.

Objective: To report the changes in veterinary surgeon schedules, workflow, and job satisfaction associated with the COVID-19 pandemic from 2020 through 2021. Methods: A voluntary, nonincentivized, anonymized 40-question internet survey was deployed from November 2021 through February 2022. Veterinary surgeons were surveyed regarding schedule alterations and support implemented by their employers during the pandemic as well as changes in their job satisfaction. Associations between demographics and responses were analyzed. Results: 333 respondents, including veterinary surgeons and residents, participated. Most respondents worked in private clinical practice (211 of 320 [65.9%]), followed by academia (95 of 313 [30.3%]). The pandemic significantly affected the work schedule of 245 of 333 respondents (77%), especially those in private practice and influenced by employment position, such as staff surgeon versus owner. 185 of 245 surgeons (76%) reported a stressful work environment, and 244 of 320 (78%) reported an increased caseload. 244 of 320 respondents (76%) felt management responses were supportive of employees; however, only 195 of 314 surgeons (62%) believed their safety was prioritized. While overall job satisfaction decreased from prepandemic levels, 147 of 247 respondents (60%) reported that at least 1 positive change in their work environment occurred due to coronavirus disease 2019 protocols, including the introduction of curbside care and remote meetings. Conclusions: The pandemic affected the working conditions of veterinary surgeons, increasing caseloads and stress. Respondents generally felt supported by their employers who implemented positive changes. Clinical Relevance: Work environment strategies identified as positive should be embraced as workplace stress and higher caseloads have impacted job satisfaction in veterinary surgery.

Objective: To describe the procedure and short‐term outcomes of two dogs that underwent laparoscopic stapled partial cystectomy with intraoperative cystoscopy for excision of solitary, non‐trigonal, urothelial carcinoma lesions. Animals: A 12‐year‐old female spayed mixed breed and a 13‐year‐old female spayed Siberian Husky. Study design: Short case series. Methods: Two dogs were diagnosed with a solitary, ventral body to apical, urinary bladder mass (maximal dimensions 1.2 cm and 1.4 cm) on ultrasound. No gross metastatic disease was evident on staging. Both dogs underwent general anesthesia with cystourethroscopy for evaluation of the bladder tumor and lower urinary tract. Laparoscopic stapled partial cystectomy was subsequently performed for excision of the bladder mass with gross margins of 1–3 cm based on concurrent cystoscopic transillumination and assessment of mucosal changes. Two medium/thick (purple) Tri‐Staple EndoGIA cartridges (60 mm and 45 mm) were utilized to complete each cystectomy, and the excised bladder tissue was removed via a specimen retrieval bag and submitted for histopathology. The bladders were leak tested with sterile saline instilled via cystoscopy. Results: No leakage was observed from the cystectomy sites. No intraoperative or short‐term complications were reported. Histopathology was consistent with completely excised urothelial carcinoma in both cases. Conclusion: Laparoscopic stapled partial cystectomy was successfully performed with intraoperative cystourethroscopy in two dogs with apical/ventral bladder wall urothelial carcinoma. This closed cystectomy technique may reduce the risk for peritoneal seeding, though more data is needed. Further evaluation is indicated to determine the feasibility in dogs with non‐apical/ventral urinary bladder masses.

Objective: The objective of the study was to describe a single incision laparoscopic approach to ovariectomy (OVE) and ovariohysterectomy (OVH) in companion pigs. Additionally, we aimed to compare complications and outcomes between production breed and miniature pigs. Study design: Descriptive clinical case series. Animals: Twenty intact female, client‐owned companion pigs. Methods: Records from a university teaching hospital were reviewed for pigs undergoing elective OVE or OVH by single incision laparoscopic surgery (SILS) over 1 year (2023–2024). Patient signalment, presenting complaint, surgical and anesthetic techniques as well as complications were recorded. Patient follow‐up was obtained by owner phone communication at least 1 year postoperatively. Complications and outcomes were compared between production breed and miniature pig populations with Mann–Whitney and χ ² testing for continuous and categorical variables, respectively. Results: Production breed (9/20, 45%) and miniature pigs (11/20, 55%) underwent SILS OVE (16/20, 80%) or OVH (4/20, 20%). SILS OVE was successfully performed in all cases. SILS OVH was achieved in one case (25%) in which the uterus was near‐normal; additional OVH procedures (3/4, 75%) performed on miniature pigs with an abnormal uterus were converted to open because of challenges with tissue manipulation. No difference in complications or outcomes was noted between production breed and miniature pigs. Conclusion: SILS OVE appears to be a feasible and safe surgical option for both production breed and miniature pigs, with no significant differences observed between groups, while SILS OVH is feasible in select cases. Clinical significance: Single incision laparoscopic OVE is a safe and viable alternative to traditional three port laparoscopy for production breed and miniature companion pigs. SILS is an adequate technique for OVH in select patients, suggesting that further investigation of laparoscopy for porcine OVH is warranted.

Objective: To report outcomes of dogs undergoing combined endoluminal tracheal stent (ELS) and extraluminal tracheal ring (ELTR) placement for tracheal malformation and collapse. Methods: Retrospective clinical cohort study including 19 dogs diagnosed with tracheal malformation and collapse. Case records were reviewed of dogs presented for treatment of tracheal malformation and collapse between 2005 and 2022. Data retrieved included sex, breed, age at the time of each procedure, presenting clinical signs, preoperative imaging results, severity of tracheal collapse, surgical data, postoperative complications, and patient outcome. Results: The median age at the time of the initial procedure was 68.5 months (range, 37 to 132 months). Eighteen of 19 dogs (95%) were Yorkshire Terriers. Seventeen of 19 dogs (89%) underwent preoperative tracheobronchoscopy, with 15 of 17 (88%) diagnosed with tracheal malformation and grade IV collapse. Three dogs had a single-session combined procedure, and 16 of 19 dogs (84%) had a second procedure, with a median time between procedures of 68.5 months (range, 0 to 93 months). Eight of 16 dogs (50%) had a major complication requiring intervention at some point after their second procedure. Fifteen of 19 (79%) were known to be deceased, with a median survival time of 13 months (range, 0 to 75 months) postoperatively from the last procedure. Conclusions: The presence of tracheal malformation, commonly seen in Yorkshire Terriers, was a frequent justification for combined tracheal procedures. Postoperative complication rates were high, but survival times were similar to those of previous reports of dogs receiving ELTR or ELS alone. Clinical Relevance: Dogs undergoing combined procedures for tracheal malformation and collapse do not appear to have a worse prognosis than dogs undergoing only ELTR or ELS.

Objective: Investigate long-term outcomes of dogs that underwent splenectomy for nonmalignant splenic disease and evaluate the risk of postsplenectomy sequelae. Methods: This was a retrospective case series including 104 dogs undergoing splenectomy for a nonneoplastic cause. Medical records created between May 1, 2017, and July 31, 2021, for dogs with ≥ 6-month survival times were reviewed for patient signalment, weight, presence of hemoperitoneum at the time of surgery, indication for splenectomy, and histopathologic diagnosis. A survey was conducted over the phone with dog owners and referring veterinarians to obtain information on survival and incidence of volvulus or torsion of abdominal viscera, blood parasite infection, presumed vascular events, severe or repeated infection, and neoplasia following splenectomy. Survival analysis was performed to assess whether these outcome measures were correlated with mortality. Results: Median follow-up time was 31.4 months (IQR, 19.75 to 45 months). Of 104 patients, 40 (38.5%) developed subsequent neoplasia after splenectomy, 13 (12.5%) experienced a presumed vascular event, 2 (1.9%) experienced a severe or repeated bacterial infection, and none were diagnosed with a blood parasite following splenectomy. Preoperative hemoperitoneum was diagnosed in 26 of 104 patients (25.0%). Preoperative hemoperitoneum, postoperative thrombosis event, subsequent neoplasia diagnosis, and postoperative infection were not predictors of survival beyond 6 months. Age at time of surgery was associated with survival. Conclusions: Patients undergoing splenectomy for benign disease that experienced long-term sequelae were identified. However, an increased risk of death as a result of the complications was not observed. Clinical Relevance: Veterinary patients may experience long-term sequela following splenectomy; therefore, ongoing monitoring is recommended.

Objective: To compare outcomes of dogs with gastric dilatation‐volvulus (GDV) treated with open right‐sided barbed suture gastropexies (BSG) and standard right‐sided incisional gastropexies (SIG). Study design: Retrospective cohort study. Animals: Client‐owned dogs treated for GDV with BSG ( n = 58) and SIG ( n = 63). Methods: Medical records were reviewed retrospectively. Suture type and size, surgery time, perioperative complications, and survival to discharge were recorded and compared between groups. Follow up was conducted by medical record evaluation, e‐mail, or phone contact. Postoperative surgical complications, recurrence of gastrointestinal signs, gastric dilatation with or without volvulus, and survival time were recorded and compared. Categorical ( χ ² versus Fisher's exact test) and parametric versus nonparametric (paired t ‐test versus Wilcoxon Mann–Whitney test; one‐way ANOVA versus Kruskal–Wallis) methods of comparison were applied as appropriate. Results: Perioperative mortality rate was 5.79% (7/121) with no difference between SIG (5/63) and BSG (2/58) ( p = .28). Barbed suture gastropexies resulted in shorter surgical times when compared to SIG when performed as the sole procedure (53.3 versus 62.6 min, p = .03). Perioperative and postoperative surgical complications ( p = .12), recurrence of GDV ( p = .22), or gastric dilatation without volvulus ( p = .5) did not differ between groups. Postoperative gastrointestinal signs were reported in 23% of dogs with no difference between groups ( p = .33). Conclusion: Barbed suture gastropexy is a viable option for surgical management of GDV. Persistent gastrointestinal signs remain possible regardless of gastropexy technique. Clinical significance: Barbed suture gastropexy can result in shorter surgical times with similar recurrence rates to previously reported gastropexy techniques.