Outcomes and prognostic factors of surgical treatments for brachycephalic obstructive airway syndrome in 3 breeds

Objective: To determine prognostic indicators for the surgical treatment of brachycephalic obstructive airway syndrome (BOAS) and to compare the prognosis of 2 multilevel surgical procedures. Study Design: Prospective clinical study. Sample Population: Client-owned pugs, French bulldogs, and bulldogs (n=50). Methods: Noninvasive whole-body barometric plethysmography (WBBP) was used to assess respiratory function before, 1 month and 6 months after upper airway corrective surgery. Postoperatively, BOAS indices (ie, ascending severity score generated from WBBP data, 0%-100%) that equaled to or exceeded the cut-off values of BOAS in the diagnostic models were considered to have a poor prognosis. A multivariate logistic regression was used to assess predictors for prognosis. Results: The median BOAS indices decreased after surgery (from 76% to 63%, P<.0001), although dogs with indices in this range would still be considered clinically affected. Age (odds ratios [OR] = 0.96, 95% confidence interval [CI]: 0.93-0.99, P<.05), body condition (OR = 0.06, 95% CI: 0.01-0.39, P<.01), laryngeal collapse (OR = 6.1, 95% CI: 1-37.22, P<.05), and surgical techniques (OR = 7.94, 95% CI: 1.17-54.01, P<.05) were associated with postoperative prognosis. The multivariate model suggests modified multilevel surgery (MMS) may have a better outcome than traditional multilevel surgery (TMS) (P5.034). The positive predictive value of the logistic model was 84% (95% CI: 68-94%) and the area under the receiver operating characteristic (ROC) curve was 89% (95% CI: 78-99%, P<.0001). Conclusions: Younger age, normal body condition, presence of laryngeal collapse, and treatment with TMS were negative prognostic factors after surgical treatment of BOAS. MMS is recommended, particularly in dogs with a higher probability of poor prognosis.