| Summary: | Synovial sepsis is a major cause of death and loss of function in horses. Despite appropriate treatment there are cases that have persistent infections posing a welfare issue to horses. This thesis presents research identifying factors associated with outcomes.
Chapter one presents an introduction to the main principles of pathophysiology, diagnosis and treatment of synovial sepsis. Chapter two presents the first structured literature review on factors affecting outcomes after synovial sepsis. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scoping review technique was used and through transparent and rigorous methodology it identified 61 studies investigating outcomes after synovial sepsis, with only eight using suitable methodology to investigate synovial sepsis outcomes. Data was charted and categorised to identify themes of research conduct and present the risk factors that have been previously found. Key features of the research conduct of previous studies included the small case numbers, lack of advanced statistical methods, marked variation in the inclusion criteria of cases, and different measurements of outcome.
Chapter three presents a multicentre study investigating synovial sepsis where 240 horses, presented for treatment during a 15-month period at ten hospitals. Data was recorded from admission, to a minimum of 365 days after surgery. Data capture forms were used to prospectively collect information on cases including signalment, injury details, surgical details and post-operative care. Descriptive data and univariable and multivariable cox proportional hazards models were used to investigate factors associated with poor outcomes. The longterm survival rate was 89.4% and factors identified as significantly associated with death included the limb affected (forelimb), increasing duration of surgery, increasing weight, the type of synovial structure affected (tendon sheaths and bursas), and increasing duration of antimicrobial therapy.
In conclusion, the research presented in this thesis provide important information to aid identification and indication of cases associated with worse outcomes. The results will provide invaluable evidence for vets and owners to improve welfare and outcomes for horses suffering from synovial sepsis.
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