Complications in Canine Cranial Cruciate Ligament Surgery. Ron Ben-Amotz

antimicrobial protocols should be considered. Many factors can contribute to an individual's estimated risk for developing an SSI and these should be considered together before deciding to use postoperative antimicrobials. Postoperative antimicrobials should never be used as a surrogate for aseptic technique and good surgical practices.

2.6 Surveillance

      Infection control in veterinary medicine tends to be reactive instead of proactive. SSIs are often identified only when animals present for clinical signs associated with SSIs or when incidentally identified during a routine follow‐up examination. This is considered to be a form of passive surveillance, where no specific effort is made to identify SSIs [68]. Alternatively, active surveillance occurs when specific outcomes or indicators are sought to increase the rate of detection [85].

      The goals of an active SSI surveillance program are to create a monitoring system that will determine the baseline level of expected SSI within a facility. By determining the baseline, a critical limit (a value beyond the expected SSI rate) can be established to determine when interventions should be employed to reduce the risk of SSI [84]. For active surveillance to be universal, definitions of outcomes must be provided. This would require defining what constitutes an SSI (see Chapter 3 for further details) as well as defining clinical signs that may be associated with an SSI and thus warrant further direct investigation of the patient. In relation to postoperative SSIs, active surveillance can be achieved through scheduled owner contact using telephone interviews or electronic questionnaires or by communication with referring veterinarians [1, 86]. During this contact, questions can be posed with regard to incisional healing, local tissue recovery, limb use, as well as if medical interventions have been required. Ideally, these forms of communication would be performed more than once during the patient's recovery period, encompassing timeframes associated with early development (within 30 days of surgery) and late development of SSI (within 90 days of surgery) [87].

      In veterinary medicine, two prospective studies using active postdischarge surveillance for assessment of SSIs identified that 27.8–35% of all SSIs would have been missed without active surveillance [1, 86]. This is not an insignificant finding and therefore should encourage the development of active surveillance practices for SSI assessment.

2.7 Conclusion

      Overall, TPLO has higher reported rates of SSI than other methods of stifle stabilization for cranial cruciate ligament ruptures (6,10,12–20,22,24,25). This may be due to the increased soft tissue dissection, thermal necrosis of the bone, and increased surgical times compared to extracapsular repairs. When compared to other tibial osteotomies, the overall higher incidence of SSIs may only be due to the increased frequency with which TPLOs are performed and thus reported.

As SSIs lead to further medical or surgical interventions, they have been identified to cause an increased financial burden for owners, along with increased morbidity for our veterinary patients [28, 88]. Despite the increased costs, protracted recoveries and increased patient morbidities, owner assessment of long‐term outcome was not significantly affected [23]. While not all risk factors can be controlled, many risk factors can be addressed with diligent surgeon and patient preoperative preparation. Additionally, active surveillance may help to improve the rate of identification of SSIs, which may lead to earlier interventions.

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