Audit-based protocol cut SSI after equine exploratory celiotomy: full analysis

A retrospective study in Veterinary Surgery is putting a spotlight on surgical audit as a practical infection-control tool in equine hospitals. Investigators from North Carolina State University and Clemson University examined what happened after the NCSU Veterinary Teaching Hospital saw a sharp rise in surgical site infections following exploratory celiotomy in horses, with the infection rate climbing from 7.7% in 2019 to 29% in 2020. After the hospital introduced a new standard operating protocol in January 2021, the reported infection rate dropped to 2.3%, according to the study. (pmc.ncbi.nlm.nih.gov)

The backdrop is important. Exploratory celiotomy is a common emergency procedure for horses with acute abdominal pain, and surgical site infection remains one of its most consequential postoperative complications. Earlier literature has reported infection prevalence after equine celiotomy ranging from about 10% to 42%, while a 2023 retrospective analysis from Colorado State University found a lower 6.4% incisional infection rate in its own series and concluded that antimicrobial timing or duration did not clearly reduce infection or ileus risk in that population. That earlier study argued that factors beyond prolonged antimicrobial use may be more important in driving complications, and it specifically called for periodic audits of clinical practice. (pmc.ncbi.nlm.nih.gov)

In the new study, the NCSU team reviewed 448 horses that underwent exploratory celiotomy for acute abdominal pain from 2019 through 2024. Of those, 345 recovered from surgery, and 57 developed surgical site complications, including surgical site infection, hernia, peritonitis, or more than one complication. The authors said the hospital’s response began with a surgical audit designed to assess adherence to best practices and identify contributors to the increase in infections seen between 2019 and 2020. Their intervention emphasized safety culture, group problem solving, staff engagement, refinement of data collection, and ongoing monitoring. The paper positions that bundle, rather than a single isolated change, as the main reason outcomes improved. (pmc.ncbi.nlm.nih.gov)

That framing lines up with broader infection-control thinking in both veterinary and human surgery. A 2021 Frontiers paper on equine surgery audits found that formal review of antimicrobial timing and related perioperative practices could uncover gaps between day-to-day workflow and best-practice recommendations. Meanwhile, human SSI guidance continues to stress disciplined perioperative process, including appropriate timing of antimicrobial prophylaxis and immediate pre-incision skin preparation, rather than relying on prolonged postoperative antibiotics alone. (frontiersin.org)

Expert reaction specific to this paper was limited in publicly available sources at the time of reporting, but the study’s message is consistent with recent equine surgery literature: infection prevention is increasingly being viewed as a systems issue. The Colorado State analysis found no benefit from extending antimicrobial administration beyond the perioperative period and warned that extra antimicrobial exposure can add cost and potentially contribute to resistance and other complications. The new NCSU report goes a step further by showing that a hospital-wide, evidence-based review process can coincide with a major reduction in infections over several years of follow-up. (mdpi.com)

Why it matters: For equine surgeons, hospitalists, technicians, and practice leaders, this study offers a pragmatic model for quality improvement. The intervention described was designed around workflow, accountability, and standardization, not around a high-cost device or novel drug. That matters for referral centers trying to improve outcomes while managing antimicrobial stewardship, staffing variation, and pressure on case volume. It also gives clinicians language to discuss risk with pet parents: postoperative infection may not be fully preventable, but hospitals can systematically measure, review, and reduce that risk. (pmc.ncbi.nlm.nih.gov)

The findings also underscore a broader operational point for veterinary hospitals. When complication rates rise, retrospective chart review alone may not be enough; structured audit methods can help teams identify hidden process failures, align perioperative protocols, and create feedback loops that last beyond a single corrective action. The authors note that there is little veterinary literature describing a formal process for managing this kind of infection-control problem, which makes the paper notable beyond equine surgery alone. (pmc.ncbi.nlm.nih.gov)

What to watch: The next question is whether other hospitals can reproduce these results prospectively, and whether future studies can disentangle which parts of the intervention bundle, such as protocol standardization, staff compliance, or enhanced surveillance after discharge, had the greatest effect on infection reduction. (pmc.ncbi.nlm.nih.gov)