Long-term survival and risk factors associated with biliary surgery in dogs: 34 cases (1994–2004)

I ndications for biliary surgery in dogs include neoplasia of the bile duct, obstructive choleliths, inflammatory biliary tract diseases, rupture of the biliary tract, gallbladder infarction, gallbladder mucocele, extrahepatic neoplasia, and pancreatitis.[1][2][3][4][5][6][7][8][9][10][11] Biliary surgery has been associated with a high mortality rate in dogs and cats even with advanced diagnostic modalities and critical care monitoring.7,9,11 Reported mortality rates following biliary surgery vary between 0% and 73% in dogs 3,5,7,[9][10][11] and between 22% and 100% in cats.4,8 Suggested risk factors include the underlying disease, 7,8 the preoperative condition of the patient, 3,5 the procedure performed, 1 septic bile peritonitis, postoperative hypotension, and creatinine concentration.9 Most of the studies have evaluated postoperative mortality rate, but have not examined long-term outcome.The objective of the study reported here was to evaluate long-term outcome and factors that affected survival following biliary surgery in dogs. Criteria for Selection of CasesMedical records of dogs that underwent biliary surgery between 1994 and 2004 at Colorado State University and Veterinary Specialists of Northern Colorado were evaluated retrospectively.Cases of biliary disease that did not include use of surgery were excluded. ProceduresData extracted from medical records included sex, breed, body weight, age at surgery, survival time, concurrent disease, preoperative and postoperative CBC and serum biochemical panel results, coagulation profiles, temperature, heart rate, prevalence of vomiting or diarrhea, anorexia or lethargy at initial evaluation, abdominal ultrasonographic results, and surgical findings.Surgical techniques were divided into 2 groups: a biliary diversion procedure group (cholecystoduodenostomy or cholecystojejunostomy) in which the normal path of bile flow was altered and a nonbiliary diversion procedure group (cholecystectomy, cholecystotomy, choledochotomy, or choledochoduodenostomy). Bacteriologic culture (from bile, liver, or abdominal fluid), antimicrobial susceptibility, and histologic results were recorded.Postoperative complications were evaluated.Hypotension was defined as a systolic blood pressure < 80 mm Hg.Postoperative medications and duration of hospitalization were recorded.A diagnosis of DIC was made by fulfillment of at least 3 of the following criteria as described by Bateman et al 12 : abnormal aPTT or PT value, low plasma AT III activity, high