Cooking the books or simply getting the best out of the data? Assessing the nature of the relationship between variables

Fifteen risk factors associated with sudden death in Thoroughbred racehorses in North America (2009-2021)

OBJECTIVE

To identify risk factors associated with race-related sudden death in Thoroughbred racehorses in the US and Canada.

ANIMALS

4,198,073 race starts made by 284,387 Thoroughbred horses at 144 racetracks in the US and Canada between 2009 and 2021.

PROCEDURES

Study data were extracted from the Equine Injury Database, which contains detailed records of 92.2% of all official race starts made in the US and Canada during the study period. Forty-nine potential risk factors were analyzed using univariable and multivariable logistic regression. Cases were defined as race starts that resulted in fatality within 3 days of racing, in which at least 1 of 5 codes relating to sudden death was recorded. Fatalities due to catastrophic musculoskeletal injury were omitted from the study cohort.

RESULTS

536 race starts resulted in sudden death, an incidence rate of 0.13/1,000 starts. Fifteen risk factors were significantly associated with sudden death, including horse age and sex, season and purse of race, race distance, and horses' recent history of injury and lay-up. Horses racing while on furosemide medication were at 62% increased odds of sudden death.

CLINICAL RELEVANCE

Associations found between previous injury and sudden death suggests preexisting pathology could contribute in some cases. The association between furosemide and sudden death prompts further study to understand which biological processes could contribute to this result.

Does oral prednisolone treatment increase the incidence of acute laminitis?

REASONS FOR PERFORMING STUDY

It is accepted among equine practitioners that glucocorticoid treatment is a risk factor for the development of laminitis. However, there is little published evidence of a link between glucocorticoids and laminitis.

OBJECTIVES

To determine whether horses receiving oral prednisolone are at increased risk of laminitis.

STUDY DESIGN

Retrospective case-control study.

METHODS

Clinical records of horses registered with the ambulatory service at Liphook Equine Hospital between January 2001 and November 2014 were reviewed retrospectively to identify horses that had received treatment with oral prednisolone. For each treated horse, 2 time-matched controls that received veterinary attention but were not treated with prednisolone were selected. Incidence of laminitis was compared between the 2 groups and factors associated with laminitis were assessed using Cox regression analysis.

RESULTS

Of the 416 horses treated with prednisolone, 16 (3.8%) were diagnosed with laminitis subsequent to the initiation of prednisolone treatment with an overall incidence of 2.60 (95% CI 1.49-4.22) cases per 100 horse-years at risk. A total of 7 horses (1.7%) developed laminitis during the course of their treatment and 3 (0.7%) of the horses treated with prednisolone were ultimately subjected to euthanasia as a result of laminitis. A total of 46 (5.7%), of the 814 time-matched control horses were diagnosed with laminitis during the study period with an overall incidence of 3.46 (95% CI 2.54-4.62) cases per 100 horse-years at risk. Of these, 12 (1.5%) were subjected to euthanasia as a result of laminitis. There were no significant differences in the overall laminitis incidence rate (P = 0.8), incidence rate during prednisolone treatment (P = 0.09), or probability of laminitis (P = 0.3) between the 2 groups. Mean survival time was greater in the prednisolone than the control group. Equine metabolic syndrome and increasing age were associated with increased risk of laminitis.

CONCLUSIONS

Administration of oral prednisolone did not increase the risk of laminitis.

Horse-, training- and race-level risk factors for palmar/plantar osteochondral disease in the racing Thoroughbred

Reasons for performing study Palmar/plantar osteochondral disease (POD) is a common, debilitating condition in Thoroughbred racehorses; however, training- and racing-related factors associated with this disease are unknown.

Objectives To determine horse-, racing- and training-related risk factors for POD. The general hypotheses were that early training and racing, and increased intensity of racing and training, lead to increased severity of POD.

Methods The metacarpo/metatarsophalangeal joints of 164 Thoroughbred racehorses were examined at post mortem and graded for third metacarpal and metatarsal POD. The relationships between training- and racing-related factors and grade of POD in each condyle were determined using multilevel, multivariable, ordinal logistic regression models.

Results A total of 1288 condyles were graded. Factors associated with higher grades of POD were the total lifetime number of races, an increase in gallop sessions in the previous season, racing before import to Hong Kong and an increase in the number of short (8–16 weeks) between-race intervals per season. Horses in their first racing season were more likely to have lower POD grades, while horses that had a long between-race interval (greater than 16 weeks) in the season prior to euthanasia were also more likely to have lower POD grades. Lower POD grades were significantly more likely as days since last race increased up to 400 days. Age at first race was not significantly associated with grade of POD.

Conclusions and potential relevance Cumulative racing exposure and training intensity in the previous season were associated with higher grades of POD, supporting the hypothesis that the disease is due to repetitive loading. Longer between-race intervals and increased time since racing were associated with lower POD grades, which may indicate that lesions heal. Further work is required to enable optimisation of racing and training programmes to reduce the frequency and severity of this disease.

Factors affecting long-term survival of horses recovering from surgery of the small intestine

REASONS FOR PERFORMING STUDY

Epiploic foramen entrapment (EFE) has been associated with a particularly poor post operative prognosis for equine colic cases, but the reasons for this are unknown.

OBJECTIVES

To identify variables associated with post operative survival following surgery for small intestinal disease; develop a model describing long-term post operative survival; and identify reasons for the poor prognosis associated with EFE.

METHODS

Data from 382 horses undergoing surgery were used to identify variables associated with survival. A multivariable Cox proportional hazards model for post operative survival was developed and model fit evaluated.

RESULTS

The final model included the variables total plasma protein (TP) and packed cell volume (PCV) at admission, duration of surgery and the dichotomous variable relaparotomy (yes/no). Risk of death was positively associated with increasing PCV, but negatively associated with increasing TP (which decreased the probability of death). In a univariable model, EFE cases had a significantly higher death rate than other types of small intestinal disease (hazard ratio = 1.7, P = 0.035). Multivariable modelling indicated that some of the increased risk associated with EFE cases was due to lower TP values and longer duration of surgery.

CONCLUSIONS

Preoperative TP is associated negatively with the risk of post operative death in horses recovering from small intestinal surgery. Other variables associated with the probability of survival are preoperative PCV, duration of surgery and relaparotomy. The increased post operative death rate of EFE cases can be explained in part by lower TP and longer surgery times of these cases.

POTENTIAL RELEVANCE

Total plasma protein may be not simply a measure of hydration status in small intestinal colic cases, but an important determinant of survival. Further investigation of this relationship is warranted. Our model for post operative survival highlights the importance of preoperative TP, PCV and duration of surgery as prognostic indicators. This information should allow a more accurate post operative prognosis following small intestinal surgery.

Survey of the characteristics of cats owned by households in the UK and factors affecting their neutered status

Data were collected on 1260 cats owned by a random sample of UK households in 2007, by means of telephone questionnaires, which were completed by 33 per cent of the households contacted. Cats were owned by 26 per cent of these households, 42 per cent of which owned more than one cat. The owners of 622 female cats reported a total of 110 unplanned litters of kittens. Excluding cats with an unknown neutered status 92 per cent of the cats aged six months or more were neutered, but only 66 per cent of the cats aged six to 12 months were neutered. Multivariable logistic regression, based on data collected for one randomly selected cat aged four months or more in each cat-owning household, was used to identify factors affecting the cats' neutered status. Analysis of 48 sexually entire cats and 501 neutered cats showed that cats aged 10 months or more, with indoor access, that had been vaccinated within the last year or were currently registered with a veterinary practice, were more likely to be neutered than cats aged less than 10 months, without indoor access, that had been vaccinated more than one year ago or were not registered with a veterinary practice.

The effect of inotropic and/or vasopressor support on postoperative survival following equine colic surgery

OBJECTIVE

To determine the effects of dobutamine and phenylephrine on intra- and postoperative survival in horses undergoing emergency abdominal surgery.

STUDY DESIGN

Retrospective case analysis.

ANIMALS

A total of 637 client-owned horses undergoing colic surgery.

METHODS

Clinical details of horses admitted for colic surgery were recorded on a computer database. Information collected included history, clinical variables observed before surgery, anaesthesia and surgical details, and postoperative survival and morbidity rates. Details of specific importance for this study were those recorded during anaesthesia, in particular the duration of dobutamine and phenylephrine administration, separately and combined, and total anaesthesia time. Two outcomes were considered: 1) intra-operative death, i.e. death between time of pre-anaesthetic medication and recovery from anaesthesia (defined as horse walking from recovery box); and 2) all deaths, i.e. death at any time after induction of anaesthesia. The definition of 'death' included euthanasia. Univariable and multivariable statistical analyses were performed to evaluate the associations between dobutamine and/or phenylephrine use and these two outcomes.

RESULTS

Results from univariable analyses suggested that dobutamine administration was not significantly associated with increased intra- or postoperative mortality. Phenylephrine administration showed univariable association with intra- and postoperative death. However, in multivariable models adjusted for the effects of heart rate and packed cell volume at admission, the phenylephrine effect was not significantly associated with intra-operative, or other types of death.

CONCLUSION

This study provides no evidence to suggest that dobutamine or phenylephrine administration is associated with altered survival rates during or after colic surgery.

CLINICAL RELEVANCE

Our study supports previous work, suggesting that pre-existing cardiovascular status is an important prognostic determinant in equine colic cases. It provides no evidence that dobutamine or phenylephrine administration is associated with survival.