Pet health insurance reduces the likelihood of pre-surgical euthanasia of dogs with gastric dilatation-volvulus in the emergency room of an Australian referral hospital

Figures & data

Figure 1. Flow diagram describing inclusion and exclusion of cases in a retrospective analysis of the medical records (EMR) of a veterinary hospital for outcomes for dogs presenting to the emergency department with gastric-dilatation volvulus (GDV). Ownership indicates special ownership circumstances that constrain the euthanasia decision (i.e. rescue organisation, government).

Table 1. Median (min, max) age and blood lactate concentration, and number (95% CI^a) of male, desexed, and purebred dogs that had co-morbidities and were euthanised or survived in a retrospective study of dogs presenting to a veterinary hospital emergency department Australia with gastric dilatation-volvulus, categorised by whether their insurance status was known or unknown.

	Insurance status
Variable	Known (n=69)	Unknown (n=78)	P-value
Age (years)	9.0 (2.0, 15)	9.0 (1.0, 15)	0.61^b
Lactate (mmol/L)^c	5.7 (1.3, 12)	5.4 (1.2, 17)	0.55^d
Male	37 (54, 41–66)	40 (51, 40–63)	0.78^e
Desexed	42 (61, 48–72)	48 (62, 50–72)	0.93^e
Purebred	65 (94, 86–98)	71 (91, 82–96)	0.46^e
Comorbidities^f	24 (35, 24–47)	20 (26, 16–37)	0.23^e
Euthanised	37 (54, 41–66)	48 (62, 50–72)	0.33^e
Survived	28 (41, 29–43)	24 (31, 21–42)	0.21^e

^a Exact CI are reported (Collett 1991).

^b Two-sided Kruskal-Wallis rank sum test.

^c Lactate values were missing for 19 (28%) dogs with known and 24 (31%) dogs with unknown insurance status.

^d Two-sided Student’s $t$-test assuming unequal variances.

^e Pearson’s χ² test.

^f Number of animals with at least one comorbidity recorded in their medical record.

Figure 2. Proportions of dogs alive at various stages of hospitalisation for dogs that presented to the emergency room (ER) of a veterinary hospital in Australia with gastric dilatation-volvulus.

Table 2. Median (min, max) age and blood lactate concentration, and number (95% CI^a) of male, desexed, and purebred dogs and number of dogs with co-morbidities, in a retrospective study of dogs presenting to a veterinary hospital emergency department Australia with gastric dilatation-volvulus, categorised by whether they were insured or uninsured.

Variable	Insured (n=10)	Uninsured (n=59)	P-value
Age (years)	5.5 (2.0, 11.0)	9.0 (2.0, 15.0)	0.009^b
Lactate (mmol/L)^c	4.8 (1.3, 10.6)	6.1 (1.6, 12.3)	0.444^d
Male	8 (80, 44–97)	29 (49, 36–63)	0.070^e
Desexed	4 (40, 12–74)	38 (64, 51–76)	0.144^e
Purebred	10 (100, 69–100)	55 (93, 84–98)	0.396^e
Comorbidities^f	3 (30, 7–65)	21 (36, 24–39)	0.731^e

^a Exact CI are reported (Collett 1991).

^b Two-sided Kruskal-Wallis rank sum test.

^c Lactate values were missing for one insured and 18 uninsured animals.

^d Two-sided Student’s $t$-test assuming unequal variances.

^e Pearson’s χ² test.

^f Number of animals with at least one comorbidity recorded in their medical record.

Table 3. Results of univariable analyses of factors associated with the risk of euthanasia of dogs with gastric dilatation-volvulus after presentation to a veterinary hospital emergency department in Australia.

	Euthanised
Risk factor	Yes	No	Total	IR^a	RR (95% CrI or CI)	P-value^b
Insurance status
Yes	0	10	10	0	Reference
No	37	22	59	63	9.2 (2.1–197)^c	–
Total	37	32	69
Sex
Male	16	21	37	43	Reference
Female	21	11	32	66	1.5 (0.97–2.4)	0.06
Total	37	32	69
Age category^d
Non-geriatric	11	24	35	31	Reference
Geriatric	26	8	34	76	2.4 (1.4–4.1)	<0.01
Total	37	32	69
Breed category
Mixed breed	1	3	4	25	Reference
Purebred	36	29	65	55	2.2 (0.40–12)	0.24
Total	37	32	69
Comorbidities
Not recorded	23	22	45	51	Reference
Yes	14	10	24	58	1.1 (0.73–1.8)	0.57
Total	37	32	69
Lactate category
Low (<6 mmol/L)	8	18	26	31	Reference
High (≥6 mmol/L)	11	13	24	46	1.5 (0.72–3.1)	0.27
Not measured	18	1	19	95	3.1 (1.7–5.5)	<0.01
Total	37	32	69

Note: CrI: credible interval.

^a Incidence risk (IR) of euthanasia (number of euthanised dogs per 100 dogs at risk).

^b Significance of likelihood-ratio test.

^c Bayesian estimate of the RR, accounting for zero cell contingency table frequencies as described in the text.

^d Animals were classified as geriatric if their age met or exceeded reported median longevity for each breed.

*Collett D. Modelling Binary Data. Chapman & Hall, Boca Raton, FL, USA, 1991

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