Outpatient surgery for animals with pyometra provides good outcome for dogs and cats

Surgical treatment with ovariohysterectomy (OHE) is the safest and most effective option, as it removes the source of the infection and prevents recurrence. Mortality rates for OHE in pyometra cases have been documented at 3% to 20%. ^1,2

With rising veterinary costs, the financial burden of even routine care is becoming increasingly challenging for many middle- and lower-income earners. According to the University of Tennessee’s Program for Pet Health Equity, the most common reason for lack of veterinary care was financial.³ Emergency surgical treatment of dogs and cats is often unattainable for some clients, leaving few, if any, affordable options for treating their pets. Reported costs for surgical treatment of pyometra vary widely by type of veterinary practice, with emergency providers being most costly, private practitioners charging somewhat less, and community clinics offering more affordability than the other categories.^4,5 One report in 2022 showed median costs for OHE with pyometra were $1000 for a medium-sized dog and $750 for a cat among surveyed private practitioners, whereas surveyed community clinics reported median costs of $200 for a medium-sized dog and $125 for a cat.⁵ Anecdotal reports for pyometra treatment relayed by clients range from $6000 to $10,000 among emergency services providers and $2000 or more at private practices in the geographic region (greater New York, New York area) served by the community clinic reporting here. These anecdotal reports likely include inpatient care following OHE.

Some private veterinary practices and veterinary emergency providers already refer pyometra cases to community clinics for more affordable surgical treatment when finances are a concern.⁵ Additionally, desperate but resourceful clients are finding nonprofit community clinics, and these clinics are stepping up to bridge the gap in affordable surgical treatment for pyometra. Providing outpatient pyometra surgery has been shown to yield positive outcomes for most of these animals across various veterinary settings.^6-7

This article demonstrates that outpatient OHE for pyometra is highly successful, as evidenced by survival rates for surgical treatment at a veterinary community clinic over 16 months. As the veterinary community works to improve access to veterinary care, cost-saving options such as outpatient surgery provide a more affordable option for clients in pyometra cases.

Case selection

All dogs and cats treated surgically with OHE for pyometra at the People for Animals (PFA) clinic, a nonprofit community veterinary provider with a focus on spay/neuter and preventive care that offers a limited array of services on an outpatient basis, in Hillside, New Jersey, between October 1, 2022, and January 31, 2024, were identified via a search of medical records (N = 447).

All surgeries were performed by licensed veterinarians, most of whom have 10 years or more of practical experience in high-quality, high-volume spay/neuter (HQHVSN) and have specialized surgical training in HQHVSN techniques. These include adopting efficient surgical techniques like optimal patient positioning, smaller incisions, pedicle autoligation, and the modified Miller knot.⁸

Standardized species-specific anesthesia protocols were used and may have been adjusted for sick patients. Intravenous (IV) access was secured preoperatively at the surgeon’s discretion. Most patients received fluid support, commonly administered subcutaneously (SQ), before and/or after surgery at the surgeon’s discretion. Perioperative pain management, antiemetic (maropitant citrate or ondansetron) injection, and Pen-G procaine intramuscular were administered to all patients. Patients were discharged after recovery from anesthesia at the end of the day. Oral antimicrobials (amoxicillin/clavulanate or cephalexin per surgeon preference) and oral nonsteroidal anti-inflammatory drugs were prescribed postoperatively. All animals were encouraged to return to the clinic as needed for a recheck if not eating or drinking or for any postoperative concerns. Sicker animals were often scheduled for recheck visits in clinic 1 to 3 days after surgery, and/or the surgeon maintained close telephone contact with the owner during early recovery.

Procedures

Cats and dogs that received OHE for pyometra were identified through a search of PFA’s medical record database, Impromed. Fifteen or more days after surgery, follow-up telephone calls to clients were conducted by staff or volunteers on various days of the week, including weekends, and at varying times of day. At least 1 month after the conclusion of the reporting period, a medical record review was conducted for patients whose owners could not be reached by telephone to determine whether any had returned to the clinic more than 2 weeks after surgical treatment.

Data collected included the patient’s name, species, age, breed, and weight; the owner’s full name and phone number; the date of surgery; postoperative contact; and death (if applicable).

Patients’ health status and labs results are known to improve rapidly postoperatively and often normalize within 2 weeks following OHE for pyometra.^1,9,10 Therefore, survival for a minimum of 14 days following surgery was defined as a “good” outcome, whereas mortality within 14 days of surgery was considered a “poor” outcome for this analysis.

Survival for 14 days was determined using several methods: telephone follow-up by the surgeon; telephone follow-up to the owner, administered by staff or volunteers; or documentation in the medical record that the patient was seen by a veterinarian at a PFA clinic more than 14 days postoperatively.

Cost analysis

A 2020 study reported median costs for surgical treatment of pyometra in HQHVSN practices at $200 for a medium- sized dog and $125 for a cat. Private practice costs in this study were estimated to be $600 to $2500 for a medium-sized dog, whereas services at emergency practices ranged from $1500 to $3500.⁴

A similar study in 2022 examined costs of pyometra treatment at private practices, reporting median fees of $1000 for a medium-sized dog and $750 for a cat. Surveyed private practitioners further estimated that, among pyometra cases declined for treatment, 48% go to emergency providers, 33% are euthanized because of a poor prognosis, and 32% are euthanized for economic reasons.⁵

Prices for pyometra treatment at the HQHVSN clinic in this report, which is in the greater New York, New York, market, were $515 for a medium-sizeddog and $315 for a cat. These fees include surgery/anesthesia, IV or SQ fluids, pain control, antiemetics, and antibiotics. Postoperatively, follow-up consultations were available as needed; clients were charged an office visit fee of $20 as well as itemized fees for treatments performed and/or medications dispensed as indicated.

Results

A total of 447 patients who underwent OHE for a diagnosis of pyometra at the PFA clinic in Hillside, New Jersey, between October 1, 2022, and January 31, 2024, were identified through a procedure search of the clinic’s electronic medical record database. Of these, 74% had follow-up more than 14 days after surgery, by telephone contact with the client or by evaluation in the clinic; the remaining 26% were lost to follow-up.

The 331 animals in this analysis include 98 (30%) cats and 233 (70%) dogs. Median age in cats was 5 years, with an age range of 6 months to 15 years. Cat breeds included 94 domestic mixes plus 4 different purebreds.

Median age among dogs was 8 years, with an age range of 9 months to 16 years. Breeds and mixes of dogs most frequently appearing in the sample include pit bull–type breeds (29%), Yorkshire terrier (13%), shih tzu (12%), Chihuahua (6%), and toy poodle (5%), with Maltese and French bulldogs each making up 3% of the sample. Two percent were mixed small breed not otherwise specified, whereas the remaining sample consisted of less than 2% of each of the following breeds: miniature schnauzer, Pomeranian, Labrador retriever mix, pug, husky, goldendoodle, German shepherd, English bulldog, Doberman pinscher, Pembroke Welsh corgi, cocker spaniel, Saint Bernard, miniature pinscher, golden retriever, vizsla, silky terrier, Rottweiler, Portuguese Podengo, Pekingese mix, Old English bulldog, Lhasa apso, Jack Russell terrier mix, West Highland white terrier, chow chow, Cavalier King Charles spaniel, Cairn terrier, Brittany spaniel, Brazilian terrier, and boxer.

Outcome

A total of 316 of 331 (95.5%) animals survived at least 14 days postoperatively. Dogs survived in 222 of 233 cases (95.3%), and 94 of 98 (95.9%) cats survived 14 days following surgery (Figure).

These results are largely consistent with previously reported survival statistics for surgical treatment of pyometra in dogs and cats. Although delays between diagnosis and surgical intervention were not specifically investigated, ASPCA research suggests that such delays may occur without detrimental outcomes.² Similarly, effects of age, breed, and existence of comorbid disease were not examined.

Discussion

Consideration of economic factors in treatment planning is a routine part of modern veterinary practice. Rising costs of living and inflation, increasing costs of care, and limited participation in third party pet health insurance have profound effects on our ability to render care in treatable cases. Too often, affordability is the primary determining factor in the choice between treatment and euthanasia.

The results presented in this report provide additional support for considering the elimination of inpatient care following OHE for canine and feline pyometra cases when financial constraints are at issue. Whether practitioners perform surgery on an outpatient basis in their own practice or refer pyometra cases to a community clinic for surgery with follow-up in the original practice, veterinarians can expect excellent survival rates while reducing financial burdens on clients. Referral to a community clinic with surgery provided on an outpatient basis is a viable alternative for those pet owners who consider euthanasia due to the cost of traditional pyometra care.

References

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