Foreword

      When I was invited to write this foreword to the book Complications in Equine Surgery, Dr. J.D. Wheat’s (R.I.P.) wise insight at the outset of my equine surgery residency immediately came to mind. He was then an internationally renowned equine surgeon at the University of California, Davis, and a man of few, but often “powerful” words! I had a case that developed a wound infection after the placement of an implant following an eye enucleation. A colleague passed by and encouragingly piped up that it never happened to their cases! Dr Wheat’s retort was: “If it didn’t happen, it is because you never did enough!”

      The editors, Luis Rubio‐Martinez and Dean Henrickson, are to be commended for tackling this challenging, important surgical topic. They are experienced and internationally renowned equine surgeons and appropriate leaders for this tome. They have lined up an impressive team of knowledgeable equine surgeons from all over the world, with pertinent expertise to address the plethora of complications that may arise following equine surgical interventions.

      Complications are, unfortunately, part and parcel of our surgical discipline. Indeed, they are perhaps one of the most challenging parts of our working lives. Paradoxically, a lack of exposure during residency training can leave less experienced surgeons feeling ill‐equipped to deal with them. A variety of emotional responses are triggered when surgical complications arise. Depending on experience, these may include feelings of failure, guilt, shame, anxiety, or embarrassment. For some, a natural instinct is “fight or flight,” while others choose to “bury their head in the sand,” or worst of all – blame others. Although the equine surgical patient may be harmed and the first victim of a surgical technical error, the surgeon may also be the second victim in emotional terms [1], particularly when serious complications arise.

      It is usually a humbling experience that we should learn from. The ideal approach when complications arise is to accurately diagnose the nature of the problem, analyze the cause, treat it to the best of our ability using an evidence‐based approach, and learn from it. Rapid disclosure of adverse events to the horse owner with good professional communication and thorough documentation will help avoid litigation or, at the very least, prepare for it. The art of communication will help the experienced surgeon navigate these knotty situations, and junior surgeons and residents should listen well and consult and learn from more experienced colleagues. Talking to a colleague about the surgical error [1] may also help to reduce the emotional burden incurred by the surgeon implicated.

      The word complication is derived from the Latin word complicare for a fold, the opposite to smooth – the desired outcome following a surgical intervention. F.D. Roosevelt’s statement “A smooth sea never made a skilled sailor” is fitting for surgery and surgeons! The words complication and adverse event, although they have different meanings, are often used interchangeably. Adverse events have been defined as “an unintended injury or complication resulting in prolonged length of hospital stay, disability at the time of discharge, or death caused by healthcare management and not by the patients’ underlying disease” [2]. Adverse events may cause preventable equine patient harm, prolong hospitalization, and increase costs. It is interesting that most adverse events in human hospitals are associated with surgery [3]. Furthermore, surgeons should note that non‐operative management errors were more frequent than errors in surgical techniques and included monitoring, incorrect or delayed treatment, diagnostic error. or delay [4]. Complications may be a consequence of an adverse event, but an adverse event may occur without complication.

      Careful surgical planning (patient, surgical theatre, and equipment) and communication with the surgical team, intraoperative technique, and perhaps most important, non‐operative management, should keep complications to a minimum.

Unfortunately, evidence‐based information on complications in equine surgery is not always available, as some of the equine surgical complications are extremely rare and treatment depends on the creativity and experience of the attending surgeon at the time. This is often the real‐life situation!

      Future efforts to improve patient safety should target research on the leading causes of potentially preventable equine patient surgical harm, identified from collected data on the frequency, severity, and preventability of adverse events. The Clavien‐Dindo classification of surgical complications, now widely employed in human surgery, or variations thereof, would be a useful tool for grading complications in future equine studies [5].

      A text book addressing this subject is timely, unique, and fills an important niche and will be an invaluable and comforting “go‐to” resource, particularly for less experienced junior surgeons, to provide guidance on decision‐making in challenging cases. It will provide access to the experience of many expert surgeons. Niels Bohr stated that “an expert is a person who has made all possible mistakes in a small field!” Hopefully, this body of work will inspire and pave the way for new research studies on this topic to move this important surgical field forward.

       Professor Sheila Laverty MVB DACVS DECVS.Faculty of Veterinary Medicine, University of Montreal, St. Hyacinthe, Canada

References

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