Ensuring the quality of high-volume spay-neuter
A veterinarian at a typical high-quality, high-volume spay-neuter (HQHVSN) clinic may do as many as 60 surgeries in a day, which have caused some to question whether these operations sacrifice quality for the sake of numbers.
A growing body of research, however, shows HQHVSN surgeries that follow veterinary guidelines can be done quickly and at a high standard without compromising patient health or welfare, according to Dr. Becky L. Morrow.
“Keep in mind these techniques are backed by over 15 years of experience and tens of thousands of patients. They’re backed by experts in the field, including board-certified surgeons, specialists in shelter medicine, public health, and animal behavior, and backed by the scientific literature,” she said.
Dr. Morrow is an assistant teaching professor at Pennsylvania State University and an adjunct professor at the University of Florida College of Veterinary Medicine. She was skeptical initially of HQHVSN until she began reading scientific reports compiled by the Association of Shetler Veterinarians and others, and saw the clinics in action herself.
Now Dr. Morrow, who is president and medical director of the nonprofit pet charity Frankie’s Friends, teaches workshops on HQHVSN. On June 25, she presented the session “High-Quality High Volume Spay/Neuter in Practice: An Evidence-Based Approach” during AVMA Convention 2024 in Austin, Texas.
She walked session attendees through the protocols and stations of a HQHVSN operation, starting with intake and finishing with discharge. “It’s not going to look anything like the surgery and general practice you’re used to. There's a lot of moving parts and a lot of people doing different things, but everybody knows what's happening, and everybody does what they need to do to help those animals,” Dr. Morrow said.
Her presentation centered on feline patients within a HQHVSN setting. Cats stay in their carriers or traps for the day to minimize stress and exposure to other animals. The anesthetic protocol Dr. Morrow follows for feline patients is intramuscular sedation using a combination of butorphanol, dexmedetomidine, and ketamine (TDK IM).
As Dr. Morrow explained, the TDK IM protocol minimizes stress and facilitates handling.
“I was introduced to this protocol over 20 years ago from a veterinary anesthesiologist and have used it on more than 100,000 cats in multiple clinics and shelters,” she said. “It’s predictable and allows for smooth induction and recovery.”
Intubating feline patients has not been a problem, Dr. Morrow added. If intubation is not an option, she uses a mask with isoflurane. A size 3.0 tube is used for adult cats and size 2.5 tube for kittens. No lidocaine is administered, nor is a laryngoscope used.
Fluids are not routinely administered during surgery, Dr. Morrow said, except for pregnant spays and animals that appear ill. Fluids can contribute to hypothermia if not heated, she said, adding that blankets are used post-op to maintain the recovering patient’s body temperate.
Following surgery, staff members and volunteers monitor each patient’s recovery. They administer meloxicam and buprenorphine for pain relief. Vaccines, as well as flea and ear mite medications, are also given. Additionally, adult cats receive 1 cc of penicillin G while kittens receive 0.55 cc.
“We may be scared to do (HVHQSN) because we were taught a certain way, but there are different ways of doing things. I want you to realize that we have guidelines and a growing body of scientific literature, and we’re getting new data all the time,” Dr. Morrow said.
A version of this story appears in the October 2024 print issue of JAVMA