BACKGROUND Previous studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited. OBJECTIVES To investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections. STUDY DESIGN Retrospective analysis of clinical records. METHODS Medical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow-up questionnaire was used to determine survival and return to athletic performance. Descriptive statistics and Cox proportional hazards survival models were used to determine factors associated with survival. RESULTS Horses underwent one (n = 107), two (n = 19), or three (n = 2) surgeries. Survival to hospital discharge was 84.4%. Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (hazard ratio, [HR] 0.41, 95% CI 0.18-0.91, P = 0.03). Increased mortality was associated with bone fracture/osteomyelitis (HR 2.43, 95% CI 1.12-5.26, P = 0.03), tendon involvement (≥30% cross sectional area) (HR 3.78 95% CI 1.78-8.04, P = 0.001), duration of general anaesthesia (HR 1.01, 95% CI 1.00-1.02, P = 0.04), post-operative synoviocentesis (HR 3.18, 95% CI 1.36-7.43, P = 0.006) and post-operative wound dehiscence (HR 2.5, 95% CI 1.08-5.65, P = 0.04). Multivariable Cox proportional hazards model revealed reduced mortality after systemic antimicrobial administration prior to referral (HR 0.25, 95% CI 0.11-0.60, P = 0.002) and increased mortality with tendinous involvement (≥30% cross-sectional area) (HR 7.92, 95% CI 3.31-19.92, P<0.001). At follow-up (median 30 months, range 0.25-13 years, n = 70) 87.1% horses were alive, 7.1% had been euthanised due to the calcaneal injury and 5.7% had been euthanised for unrelated reasons. From 57 horses with athletic performance follow-up, 91.2% returned to the same/higher level of exercise, 5.3% to a lower level and 3.5% were retired due to persistent lameness of the affected limb. MAIN LIMITATIONS Retrospective study and incomplete follow-up. CONCLUSION Endoscopic treatment of contamination/sepsis of the calcaneal bursae has an 84% survival rate to hospital discharge. Tendinous involvement reduced survival whilst systemic antimicrobials administration prior to referral improved survival.

中文翻译：

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一项多中心队列研究，调查内窥镜灌洗和清创治疗的马跟骨滑囊的滑膜污染或败血症的结果。

背景 先前研究与内窥镜治疗跟骨囊污染/脓毒症后生存相关的因素的研究是有限的。目的 调查内窥镜治疗的跟骨滑囊污染/败血症与马存活相关的因素，并描述滑膜感染中涉及的细菌分离物。研究设计 临床记录的回顾性分析。方法 回顾了 7 家马医院内镜灌洗治疗的 128 匹跟骨囊污染/败血症的病历。后续问卷用于确定生存和恢复运动表现。描述性统计和 Cox 比例风险生存模型用于确定与生存相关的因素。结果 马接受了一次 (n = 107)、两次 (n = 19) 或三次 (n = 2) 手术。出院生存率为 84.4%。单变量生存分析显示，转诊前给予全身性抗菌药物与降低死亡率相关（风险比，[HR] 0.41，95% CI 0.18-0.91，P = 0.03）。死亡率增加与骨折/骨髓炎相关（HR 2.43, 95% CI 1.12-5.26, P = 0.03），肌腱受累（≥30% 横截面积）（HR 3.78 95% CI 1.78-8.04, P = 0.001），全身麻醉持续时间（HR 1.01, 95% CI 1.00-1.02, P = 0.04），术后滑膜穿刺术（HR 3.18, 95% CI 1.36-7.43, P = 0.006）和术后伤口裂开（HR 2.5, 95 % CI 1.08-5.65，P = 0.04）。多变量 Cox 比例风险模型显示，转诊前全身性抗菌药物给药后死亡率降低 (HR 0.25, 95% CI 0.11-0.60, P = 0.002)，肌腱受累死亡率增加 (≥30% 横截面积) (HR 7.92, 95 % CI 3.31-19.92，P<0.001)。在随访中（中位 30 个月，范围 0.25-13 年，n = 70）87.1% 的马还活着，7.1% 的马因跟骨损伤而被安乐死，5.7% 的马因不相关的原因被安乐死。对 57 匹马进行运动表现随访，91.2% 恢复到相同/更高的运动水平，5.3% 降低到较低水平，3.5% 因患肢持续跛行而退役。主要局限 回顾性研究和不完整的随访。结论 内镜治疗跟骨囊污染/脓毒症的出院生存率为84%。肌腱受累降低了存活率，而转诊前全身性抗菌药物给药提高了存活率。