An efficient and not
protracted surgery is important for the safety of the
animal and for the productivity of the surgeon. Surgical
audits need to be done by the licensee so
as to maintain a high standard of care and build up the
reputation of the veterinary surgery.
I publish some bench-marks of how long I take to
spay a small breed with false pregnancy and one with
pyometra
1. KPI for spaying
a dog with false pregnancy
1. A: IV inj Dom +
Ket: 3.17pm
2. B: Isoflurane gas first
given: 3.27pm
3. C: Isoflurane gas
stopped: 3.47pm (spay and
then dental work)
4. D: First skin incision:
3.31pm
5. E: Skin stitched: 3.50pm
E-D = 19 minutes E-A = 33
minutes
Spay of a small
breed should be less than 20 minutes. One of my cases
is shown in the image. It takes 19 minutes to
operate in this case. Just be careful about the
false pregnancy milk falling
into the abdomen.
Overall, the process takes 33 minutes. The lady owner in
her late 40s and her mother had gone to the temple to
pray for a good outcome.
During surgery, there was some bleeding as the ovaries
were abnormal. Probably polycystic. This dog has false
pregnancy at around 3-monthly and even produced milk at
the 26th day after spay.
No need to return for stitch
removal in 99% of my spay
cases as the stitches do
dissolve and the surgical
wound do heal well as in
this case. No extra
subcuticular stitches are
done by me in all spays and
so there is less suture
irritation and stitch
abscesses.
Stitching
involves the linea alba and
skin only. Keep spay simple
and short. No fanciful
"hidden SC stitches" to
impress the owner but if you
want to do it, use an
appropriate smaller sized
needle and 3/0 suture.
The dog is more "aggressive"
after spay. She still
produces milk even 26 days
after spay. Why? This
behaviour is hard to explain
as the dog may be protecting
herself against dressing
changes by the lady owner.
She has a history of false
pregnancies every 3-4 months
and her estrus cycle was not
normal.
2. Spaying a dog with pyometra
1.
A: IV inj Dom + Ket 10.07 am
2. B: Isoflurane gas first given 10.09am
3. C: Isoflurane gas stopped: 10.51am (spay and
then dental work)
4. D: First skin incision: 10.18 am
5. E: Skin stitched: 10.44 am
E-D =
26 minutes E-A = 37 minutes
A small breed dog or cat spay should be
completed (E-D) in less than 20 minutes and (E-A)
should be less than 30 minutes.
For pyometra as in the above dog, the time taken
is 26 minutes. It takes longer as the womb
is filled with pus and extra care and longer skin
incision are needed during surgery.
I am still
doing a trust and audit check on my vets to make
sure that the time spent/spay is not too long due
to lack of planning and inefficiency or idle
chatting. Employees love to chat and that is part
of human nature. However, no chats should be done
during surgery as there must be focus on
the patient's life. Proper accounting must be done
to ensure that the business can survive in this
harsh economic environment esp. with the impending
world recession due to the euro crisis.
CONCLUSION
A database of the process of spays done by associate
vets at Toa Payoh Vets will enable me to know the
efficiency and productivity of the veterinary surgeons.
For example, I have encountered vets using 2 packets and
3 packets of
sutures to spay a small and large breed dog respectively. This is not a best
practice and the vet has to find out why he or she needs
to use more packets when the usual practice is one or
two packets.
TOA
PAYOH VETS
