Background Operating theatres are major generators of waste and greenhouse gases. Methods The weights / types of waste from equine orthopaedic, colic, soft tissue and arthroscopic surgeries (convenience sampling) were audited during three six months periods: period 1, prior to intervention; period 2, following training / education of teams about waste segregation; period 3, following introduction of reusable surgical textiles (drapes, gowns, instrument packaging). Results In all surgery types, the mean total waste mass in period 3 was lower than the other two time periods. For all surgery types, the mean percentage of the waste that was offensive reduced from period 1 to period 2, followed by a further reduction in period 3. In all surgery types, the mean percentage of domestic waste was higher in period 3 than in period 1. The mean percentage of recyclable waste was lower during period 3 than during period 2. Main limitations Low numbers of surgeries. Conclusions Education and training of surgical teams on appropriate waste segregation and introduction of reusable surgical textiles resulted in reduced total waste and offensive waste, and increased domestic waste generated in equine surgery. These changes have reduced the carbon footprint of equine surgery in this theatre.

Background: Antimicrobials essential for human health must be used judiciously. Objectives: Quantify current use and indications for critically important antibiotics (“protected antibiotics”) in general equine practice. Study Design: Prospective descriptive. Methods: Systemic use of 3 rd generation cephalosporins (ceftiofur), fluroquinolones (enrofloxacin and marbofloxacin), macrolides (clarithromycin), ansamycins (rifampin) and polymyxins (polymyxin B) (classified as “protected antibiotics”) were prospectively recorded in 19 equine practices over a six-month period (April - September 2023). Results: Protected antibiotics were prescribed to 200 horses with 10 horses prescribed two protected antibiotics concurrently. These included ceftiofur (48.2%), enrofloxacin (34.3%%), marbofloxacin (7.1%), polymyxin B (6.2%), rifampin (2.8%) and clarithromycin (1.4%). The mean number of protected antibiotics prescribed per practice was 10.5 (SD 12.4, range 0-41). The commonest clinical indications were respiratory disease (18.0%), foal septic diseases (16.5%), gastrointestinal diseases (15.0%), complicated wounds (13.5%), “dummy”/premature foals (7.5%) and cellulitis/lymphangitis (6.5%). Of 190 horses prescribed protected antibiotics, 76 (40.0%) were foals (less than 12 months of age). Horse age (foal or adult) was associated with specific antibiotic use (p < 0.001), with 73.7% of ceftiofur prescriptions for foals, and 97.0% and 100% of enrofloxacin and marbofloxacin prescriptions respectively for adults. Horses less than one year of age were less likely to have culture and antibiotic susceptibility testing (AST) compared to adults (P < 0.001). Commonest justifications for protected antibiotic use were lack of alternative preparations suitable for foals (27.5%), AST results (24.9%) and failure to respond to previous antibiotic treatment (17.1%). Main Limitations: Convenience sampling with small number of cases. Aminoglycoside use not evaluated. Conclusions: Respiratory and gastrointestinal diseases, complicated wounds and foal infections were the commonest reasons for protected antibiotic use. Lack of alternative drugs (for foals) and C&S results or failed previous treatments were commonest justifications.

Background: No large study has examined the treatment and response to treatment of horses with sinonasal disease confirmed by computed tomography (CT). Objectives: Report the treatment and response to treatment of referred cases of equine sinonasal disease. Study design: Retrospective case series. Methods: Data were collected from 19 equine hospitals on 1600 CT-confirmed cases of sinonasal disease. Results: Surgical sinus treatments were performed under sedation in 78.4%, under general anaesthesia in 11.0% and the remaining cases did not have surgical sinus treatments. Sinoscopic debridement with maxillary septal bulla fenestration was performed in 754 horses, under sedation in 605 horses and under general anaesthesia in 139 cases. Nasofrontal and maxillary sinusotomies were performed in 324 and 93 cases, respectively, under sedation in 302/417 cases (72.4%) and general anaesthesia in 115/417 (27.6%). Sinoscopic lavage was performed in 711 cases, usually following other procedures. Sinoscopic treatment was associated with a higher likelihood of cure, and nasofrontal sinusotomy with a lower likelihood of cure, but more difficult cases may have had more sinus osteotomies. Primary, dental and mycotic sinusitis had the highest complete cure rate (all over 79%), while sinus neoplasia (7.3%) and PEH (40.4%) had the lowest cure rates. A total of 592 cheek teeth extractions (including 323 Triadan 09s) were performed in 488 horses with dental sinusitis, including by oral extraction (n=478, 80.4%). Oral extraction was associated with the highest likelihood of complete cure (84.5%), while standard repulsion and surgical buccotomy had the lowest likelihoods of cure (78.6% and 66.7% respectively). Overall response to treatment was available for 926 cases, showing 645 horses (69.7%) cured, 156 (17.0%) partially cured, and 125 (13.5%) not cured. Main limitations: This was a retrospective study. Data on treatments and response to treatments were not available for all cases.

Background: The diagnosis of equine sinonasal disorders has been greatly enhanced by the use of computed tomographic (CT) imaging Objectives: Report the causes of equine sinonasal disease in a large number of referred cases, all of which underwent CT imaging. Study design: Retrospective case series. Methods: Data were collected from 19 equine hospitals on cases of sinonasal disease they had examined, all of which underwent CT imaging. Results. Sinusitis was unilateral in 1457 cases and bilateral in 143. Dental sinusitis due to apical infection was the most common cause of sinusitis (n=693; 43.3% of cases). Other causes were primary sinusitis (n=329; 20.6%), sinus cyst (n=178; 11.1%), progressive ethmoid haematoma (PEH) (n=100; 6.3%), traumatic sinusitis (n=90; 5.6%), sinus neoplasia or suspect neoplasia (n=86; 5.4%), other non-neoplastic sinus growths (n=11; 0.6%), mycotic infection (n=65; 4.1%), sinus pneumocele (n=5; 0.3%), oro-nasal fistulae related sinusitis (n=4; 0.25%), sinus mucocele (n=2; 0.13%), facial suture infection (n=1;0.06%) cases. Sinus tumours and PEH had a significantly lower likelihood of cure than all other diagnoses. Facial swelling was more common with sinus cysts, tumours, trauma and mycosis than other diagnoses. Nasal malodour was most common with dental sinusitis. Nasal airflow obstruction was most common with sinus cysts, PEH and tumours. Empyema of the nasal conchal bullae was least common with sinus cysts, PEH, trauma and tumours (less purulent types of sinusitis). More severe grades of hyperostosis were associated with sinus cysts and tumours. Main limitations: This was a retrospective study, and no histology was performed in some cases.

Background: No study has described the computed tomographic (CT) sinonasal findings in a large cohort of referred cases. Objectives: Report the CT imaging findings in cases of sinonasal disease referred for advanced imaging and treatment. Study design: Retrospective case series. Methods: Data were collected from 19 equine hospitals on referred cases of sinonasal disease, all of which had undergone CT imaging. Results CT imaging in 1600 cases of sinus disease showed unilateral sinusitis in 1457 and bilateral sinus disease in 143 cases. The findings in the 1457 unilateral cases and the initially affected side in the 143 bilateral cases (n=1600) (termed side A) showed the rostral maxillary sinus was affected in 1377/1600 horses (86.1%), with 74.8% of the ventral conchal, 67.7% caudal maxillary, 52.1% conchofrontal, 31.2% ethmoidal (middle conchal) and 28.6% of sphenopalatine sinuses affected. Fluid attenuation or distortion of the ventral nasal conchal bulla (NCB) was present in 21.3% and 39.3% of cases, respectively, and fluid attenuation or distortion of the dorsal NCB was present in 16.5% and 28.4% of cases, respectively. Hyperostosis (inflammatory thickening) of sinus-related bones was mild in 508 (35.5%), moderate in 283 (19.8%), severe in 124 (8.7%), and absent in 516 (36.1%) of 1431 CT records. A total of 659 non-fractured, apically infected cheek teeth and 200 fractured, apically infected teeth were found, with 52.2% of these involving the Triadan 09 position. Notably, examination of the normal contralateral sinuses in the 1457 horses with unilateral sinusitis revealed that 100 horses had CT evidence of 114 maxillary cheek apical infection within intact alveoli. This finding indicates that the presence of a tooth with CT evidence of endodontic/apical disease does not always result in sinus infection. Main limitations: This was a retrospective study with incomplete data available for some cases.

Background : Recruitment and retention of veterinarians are major problems. Objectives : Investigate equine veterinary surgeons’ perceptions about working in the UK equine veterinary industry. Study design : On-line questionnaire of veterinary surgeon members of the British Equine Veterinary Association (BEVA). Methods : The questionnaire was distributed to equine veterinary surgeons via BEVA newsletters between May and December 2022. Results : There were 480 usable responses (180 males and 297 females; median age 39 years). 81% worked full-time. 86% worked in equine practice (13% in mixed practice). 41% thought there were sufficient staff numbers relative to the workload, with a significant association with age (p<0.001). The median average working week (excluding out of hours) was 52.5 hours. 70% reported “chasing their tail” all the time / frequently. Frequent discrimination from clients was reported by 10% and was statistically associated with age (P<0.001). Over 60% reported they were worried about having complaints lodged by clients with the RCVS, statistically associated with age (p=0.007). 43% felt they received adequate mental wellbeing support from their employer. 50% acquired their current job by personal recommendation. 34.5% said they would likely to be looking for a new job in the next two years. The most important reasons why respondents would consider leaving their current job included work life balance (13%), family (112%), salary (10%), working times (7%), career prospects (6%) and out of hours rota (6%). The most important reasons for staying in their current job were location (12%), team (10%), family (8%), salary (6%), work-life balance (5%), and case load (5%). Conclusions : Recruitment and retention are important problems facing the equine veterinary profession. Working times (including out of hours), work life balance, general and mental wellbeing support remain important factors affecting equine veterinarians’ perceptions about their jobs, especially for younger veterinarians.

Background: Equine sinonasal disorders are significant diseases whose investigation and treatment have undergone significant changes over the past decade. No large study has described the signalments, pre-referral management, or the clinical and nasal endoscopic findings in such cases referred for advanced imaging and treatment. Objectives: Report the signalments, pre-referral management, and the clinical and nasal endoscopic findings of cases with sinonasal disease referred for advanced imaging and treatment. Study design: Retrospective case series. Methods: Data were collected from 19 equine hospitals on cases of sinonasal disease they had examined, all of which had undergone computed tomographic (CT) imaging. Results: 1600 cases met the requirements for the study, including 1457 cases of unilateral and 143 cases of bilateral (sinonasal disease) sinusitis. Most were chronic disorders with a mean duration of 17.9 weeks (s.d. 34.6 weeks), and 96 cases were over 12 months duration. The most common antimicrobials administered pre-referral were potentiated sulphonamides, followed by doxycycline and procaine penicillin. Pre-referral surgical treatments included maxillary cheek tooth extraction (n=234 teeth), sinoscopy (11.8% of cases), nasofrontal sinus osteotomy (5.2%) and maxillary sinus osteotomy (3.6%). Nasal airflow was obstructed in 14.9% of cases, and facial swelling was present in 26.9% of cases. Nasal endoscopy showed exudate at the sinonasal ostium in 65.8% of cases, and abnormalities, including inspissated exudate, sequestra and sinonasal fistulae, were present in the middle meatus in 44.6% of cases. Multivariable analysis showed the presence of the following variables at presentation were significantly associated with a decreased chance of complete cure: age greater than 12 years, sinonasal disease of greater than 8 weeks duration, prior nasofrontal sinusotomy, presence of facial swelling, epiphora, or bilateral nasal discharge. Main limitations: This was a retrospective study with complete data unavailable for some cases.

Background: Monitoring antibiotic use (AMU) is a key component of antimicrobial stewardship. Published AMU data in equine hospitals are limited. Objectives: Document AMU in equine hospitals. Study Design: Repeated point prevalence surveys. Methods: Prospective descriptive study. AMU recorded one day weeky for 12 months in 6 equine hospitals. Results: 1142 horses were prescribed antibiotics among 15031 horses (7.6%) hospitalised on 216 survey days. Commonest breeds were Thoroughbreds/crosses (34.7%) and warmbloods/crosses (22.5%). Median age of adults was 6 years (IQR 10, range 1-28 years) and 8 weeks for foals (IQR 14 weeks, range 1 day-50 weeks). Mean weight of 1127 horses 420kg (range 15-866kg). Commonest indications were complicated wounds (23.6%), gastrointestinal/abdominal disease (19.2%), surgical prophylaxis (15.0%) and simple wounds (11.8%); 81.4% were community-acquired conditions, 14.4% surgical prophylaxis, 3.6% healthcare-acquired. Culture and susceptability performed in 11.4%. The commonest antibiotics prescribed were procaine penicillin (41.8%), gentamicin (41.4%), potentiated sulfonamides (16.5%), oxytetracycline (10.2%), ceftiofur (9.2%) and doxycycline (8.2%). Enrofloxacin prescribed in 59 horses (5.2%) and marbofloxacin in 19 (1.7%). The mean antibiotic dosages (mg/kg) ( + SD) were: procaine penicillin 20.5 ( + 2.8), gentamicin 7.1 ( + 1.0), potentiated sulfonamides 30.4 ( + 3.0), oxytetracycline 5.9 ( + 1.0), ceftiofur 5.2 ( + 1.4), doxycycline 5.9 ( + 1.7), enrofloxacin 6.6 ( + 1.1) and marbofloxacin 3.7 ( + 1.4). Main Limitations: Systemic AMU only. The duration of antimicrobial courses not recorded. Some cases may have been double (or more)-counted if they were in the hospital on >1 survey days. Conclusions: Antimicrobials were prescribed in 7.6% of hospitalised horses. Commonest indications were complicated wounds, gastrointestinal/abdominal disease, surgical prophylaxis and simple wounds. Commonest antibiotics administered were procaine penicillin, gentamicin, potentiated sulfonamides, oxytetracycline, ceftiofur and doxycycline. Critically important antimicrobial use was uncommon. Dose rates were generally appropriate.

Background: Youngstock are particularly susceptible to parasitic disease; anthelmintic resistance is an increasing problem. Objectives: Investigate the current approaches to testing for parasites and anthelmintic use in foals and adult horses on UK studs. Study Design: Cross-setional study; on-line survey. Methods: SurveyMonkey questionnaires (multiple choice, Likert scale and free text questions) distributed via practices, press, social media and snowball sampling. Descriptive and inferential statistics performed in Microsoft Excel and STATA. Statistical differences assessed with Fisher’s exact test or Mann Whitney U test. Results: 56 usable responses. Experience, faecal egg counts and veterinary advice were considered to be the most important factors by respondents in determining anthelmintic choice. The commonest product choices overall were a moxidectin – praziquantel combination, fenbendazole and pyrantel. Timing of anthelmintic treatment for cyathostomes in broodmares was based on faecal egg counts in 58.9%; treatment for tapeworms was based on ELISA results in 10.7%. With respect to foals, 61.8% received anthelmintic treatments regardless of test results; the commonest anthelmintic products used in foals were fenbendazole (56.6%) and pyrantel (47.9%). Anthelmintic resistance on the property was reported by 27.8% of respondents, but there was no association with reported illness. Main Limitations: Small sample size. Potential selection bias and response bias. Conclusions: Over a quarter of stud owners believed that anthelmintic resistance occurred on their premises. The commonest used anthelmintic product on stud farms was moxidectin-praziquantel combination. The commonest anthelmintic used in foals was fenbendazole. Testing for tapeworms was uncommonly undertaken. Results identify areas where testing for parasites and anthelmintic use on stud farms could be improved.

Background : Pancreatitis is a poorly understood condition in the horse. The DGGR lipase assay has recently been validated for horses. Objectives : Evaluate serum DGGR lipase concentrations in equids presented to an equine hospital in the UK with gastrointestinal disease. Study design : Prospective descriptive. Methods: Blood samples were obtained by convenience sampling of horses and donkeys presented for evaluation of gastrointestinal disease. Results : Serum pancreatic (DGGR) lipase concentrations were measured in 205 equids with gastrointestinal disease, of which 147 survived, 47 were euthanised and 11 died. The median serum pancreatic lipase concentration in all animals was 17 U/l (IQR 14 – 27; range 1 – 3484). The lipase concentration was categorised as normal in 124 animals (60.5%) and elevated in 81 (39.5%). There was a statistically significant difference in the disease category and pancreatic lipase concentration (p < 0.001), with colic cases having higher lipase concentrations than colitis and peritonitis cases. There was strong evidence (p=0.01) of an association between pain severity and lipase values, with higher lipase concentrations in horses with more severe pain. Of 12 horses with severely increased pancreatic lipase concentration (>200 u/L) 3/12 had spontaneous nasogastric reflux and 6/10 had distended and/or thickened small intestine on abdominal ultrasonography; 7/12 survived to hospital discharge, and 5/12 died or were euthanised. Main Limitations : We were unable to confirm the presence of pancreatitis in any of the horses with elevated serum DGGR lipase concentrations by post-mortem examination or histopathology. Conclusions : Some equids with gastrointestinal disease have increased serum pancreatic (DGGR) lipase concentrations, especially those with colic. This suggests that a degree of pancreatitis may be present in many colic cases, although this does not necessarily indicate causation.

Background: Youngstock are susceptible to parasitic disease; the development of anthelmintic resistance is increasing. Objectives: Investigate stud owners’/managers’ perceptions of prevalence of parasite-associated diseases and current management approaches to control parasites on UK studs. Study Design: Cross-sectional study; on-line survey. Methods: SurveyMonkey questionnaires (multiple choice, Likert scale and free text questions) distributed via practices, press, social media and snowball sampling. Descriptive and inferential statistics performed in Microsoft Excel and STATA. Statistical differences assessed with Fisher’s exact test or Mann Whitney U test. Results: 56 usable responses. The median number of foals born per farm per year was 9, and the median number of resident mares/permanent boarders was 14. Predominant breeds were Thoroughbreds and Warmbloods. Perceived parasite-associated illness in the past year was reported by 35.7% respondents (weight loss (65.0%), diarrhoea (40.0%) and colic (15.0%)) with young adults (1-3 years) most affected (47.7%), followed by adults (31.8%), weanlings (27.3%) and foals (20.5%). New mares weren’t turned out until they were administered an anthelmintic in 53.6%, whilst 41.1% performed faecal egg counts and treated if necessary, and 16.1% turned mares out without treating or testing. The median stocking density was 0.3 mares / acre (significantly lower for Thoroughbreds than Warmbloods / “others” (p<0.01)). 32.1% of farms never “poo picked” pastures; 89.3% harrowed paddocks; and 57.1% co-grazed horses with ruminants. Main Limitations: Small sample size. Potential selection bias and response bias. Conclusions: Parasite-associated diseases on stud farms are common. Many farms fail to implement management practices (eg poo-picking, co-grazing with ruminants) that could reduce the risk of parasite transmission on the premises. Harrowing paddocks could increase the risks of parasite transmission. Results identify areas where management practices should be improved.

Background : Anthelmintic resistance in equine parasites is increasing. Frequent anthelmintic use accelerates selection for resistance. Objectives : Investigate how horse owners currently use anthelmintics to control intestinal parasites. Study design : Online survey. Methods: Questionnaire distributed via practices, equestrian organisations, etc., December 2021 to October 2022. Combination of multiple choice, Likert scale and free text questions. Descriptive / inferential statistics performed (Microsoft Excel and IBM SPSS). Results : 4232 useable responses. Owners of horses on livery yards less likely to make worming decisions compared to those on private properties (p<0.001); managers made decisions in 39.6% of horses on livery yards; 60.7% of owners sought worming advice from their veterinarian; 52.0% administered anthelmintics based on routine faecal egg counts (FECs) / tapeworm serology result; 30.0% routinely tested, but wormed at least once a year regardless of the results; 16.1% did not test, but wormed at least once a year. Owners were more likely to administer anthelmintics based on test results if they sought veterinary advice or were on a health programme (both p<0.001). Of those who routinely wormed, 54.9% wormed once a year; 45.1% wormed twice or more a year. Frequency of routine worming was higher if they didn’t routinely test (p<0.001); 88.9% simultaneously wormed all horses on the pasture. Moxidectin was the first choice for 82.2% of owners who routinely wormed at least once yearly. Routine FECs were performed by 84.7%, higher for those who sought veterinary advice (89.3%, p<0.001). Tapeworm ELISAs were utilised by 40.8%, higher for those on a health programme (68.1%; p<0.001); 58.5% routinely treated for tapeworms regardless of test results. Main Limitations : Selection bias. Conclusions : Owners apply moderately good diagnostic-led parasite control practices, but still common to regularly treat with anthelmintics (30.0% worming at least once a year regardless of the FEC results).