Pet Economics 101 Demystifying the cost of spays and neuters in veterinary practice

April 30th, 2008  

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Excellent explanation Dr. K!

Jason April 30th, 2008 01:57:00 PM

Excellent post - I'm going to have to forward this link to all my coworkers so we have an answer ready when clients berate us for our clinic's $250+ spay and $200+ neuter (cat or dog, includes a chem 12, CBC, IV cath., fluids, pulse-ox, ECG, pre-meds, sevo, dedicated tech monitoring during sx, a monitored day in the hospital to recover, and injectable pain meds during sx).

anna April 30th, 2008 03:14:00 PM

Hi Dr K, thanks for the excellent (as usual :) post.
I know you don't much enjoy big dog spays, but are they really more risky than with smaller dogs, or is there just MORE of everything ?
My Rottweiler is just coming into her second season, then she will be spayed before her next one. I took the deliberate choice to let her have a couple of seasons after researching the health pros and cons (Especially with Rotts being so prone to bone cancer, the evidence on that one convinced me).

Alison April 30th, 2008 03:50:00 PM

Alison: Sure, there's a lot to consider when making a decision on when to spay. Your female Rottie will surely do well. But it's not as easy a surgery as it would have been a year ago. As long as she's not overweight it's not a tremendous difference, though. She may feel more pain (so she'll need more meds for a longer period of time) and yes, there may be more risks involved. Bleeding is the major risk. But that risk is easily mitigated if the surgeon is taking his/her time and enough attention is paid during the post-operative recovery period. I'm sure she'll do great!

Dr. Patty Khuly April 30th, 2008 05:03:00 PM

Sigh...I typed in a whole bunch then must have clicked cancel....

bottom line is you get what you pay for with cheap vs expensive spays....

pulse ox...pain meds...propathol vs ketamine....quality vs cheap and quick....does it matter?..sometimes.

Will I spend more vs less on it, yes, because I think at least in the case of spays, it does matter.

However, I am concerned by the constant increase in pricing because it will lead to an already flooded "market" of unwanted cats and kittens and dogs and rabbits.

I can't support the 100-200% prescription increase just to get it at the vet's office however. Not when my husband's yearly raise last week (union) was $0.25/hour.
I get all my meds online. I just order any antibiotics I "might" need in advance and still take any sick ones to the vet. Fortunately my vet works with me that way, but I am not the average pet owner.

But if I am going to spend the big bucks...I'd rather they go to lab work, or dentals, then to hiked up pharmaceutical costs.

If my current spay/neuter project wasn't a group of small sized, FIP exposed, somewhat immuniocompromised, I might spend $55.00 on a cheapo spay rather than 5 times that at my vet.

I think those choices depend on the situation. But if the overpopulation issue doesn't get addressed more aggressively, nature will take over and we could see some unpleasant diseases emerge that risk all our pets.

LorriM April 30th, 2008 05:46:00 PM

Dr. K said:

"Bleeding is the major risk. But that risk is easily mitigated if the surgeon is taking his/her time and enough attention is paid during the post-operative recovery period"

These are important words. This is why I would caution anyone to please place quality over cost when it comes to deciding WHERE to spay a pet. I would really caution ANYONE not to skimp on this surgery.

As I've mentioned before, I spend a lot of time reading veterinary disciplinary records from state vet boards. And, in the 2007 records I've reviewed, an alarming number of them are related to spays -- and spay-related deaths. Usually, because of exactly the things Dr. Khuly has pointed out.

Now, I realize that such a high volume of spays are performed (compared to other surgeries) that in a years' worth of "surgery-gone-wrong" stories most of them are bound to be about spays, and that doesn't mean that they are unusually risky. But here are the things that have gone wrong based on these records -- not necessarily in this order (although issues with the "ligatures" not being done right do seem to be the main problem).

#1: Vet failed to use TWO ligatures rather than one. I don't know that that means exactly, but it can lead to internal bleeding.

#2. Vet failed to tie off (ligate) both uterine horns. I don't know what that means either, but it too can apparently lead to massive bleeding.

#3. Vet use the wrong suture types or placed ligatures in such a way (incorrectly) that they slipped. Again, can lead to bleeding.

#4. Failure to maintain sterile surgical environment leading to infection.

#5. Failure to suture properly, leading to bleeding and/or infection and other problems.

#6. Failure to monitor adequately during or after surgery, including use of unlicensed staff for important duties, inadequate fluids and/or inadequate or incompetent treatment of post-surgical complications; failure to ensure the patient was recovered and able to stand before releasing.

#7. Failure to refer a patient/owner to a hospital with overnight monitoring and emergency care when the patient is having serious post-surgical complications.

#8. Less severe but still maddening -- performing abdominal surgery, but not spaying the dog entirely or at all. Yup, there are cases where a "spay" has been performed and the dog comes home with an incision site and everything, went through anesthesia -- and then goes into heat. Followup reveals that the dog was never spayed, or not entirely spayed.

Bottom line -- stuff can go wrong. Do your homework. Paying lots of $$$ doesn't necessarily mean nothing will go wrong, but if some of that extra $$ goes for licensed staff, experienced surgeons with no disciplinary record of botched spays, good monitoring and pain control, and overnight monitoring if needed (or referral to overnight monitoring if needed) and good, hygienic conditions -- IMHO, it's WELL WORTH IT.

What I'd really like to know is whether the people who do high-volume spay are THE BEST at it (especially that apparently very important LIGATURE thing) because they've done so many of them -- or whether, BECAUSE of the volume, they are less likely to take all the time and care needed to do the best job. That is what I would like to know.

Stefani April 30th, 2008 06:08:00 PM

It's such a complicated issue, the price of spay/neuter surgery. On one hand, I wish wish wish that everybody who got a puppy/kitten would take into account BEFOREHAND the cost of altering that pet. But I know that will never be the reality, so I would rather see people seek out low-cost clinics than be faced with sick pyometra dogs and owners with no money that have been our specialty lately, than the oops litters that result from not altering, etc.

All my own dogs have been altered by the shelters/rescues before I've gotten them (as adults) and everybody's been fine. But they weren't *mine* yet and it wasn't my decision to make. It would never be my choice- I want the best care available, and I want to know that my pet is an individual on surgery day, not one in an assembly line of nameless pets.

katie April 30th, 2008 06:22:00 PM

Oh, I left one fatal veterinary spay error out. This has been described more than once in the documents I have reviewed.

Ligating (tying off) both ureters instead of the uterine horns. If you tie off both ureters, urine can't get out, and it results in kidney failure.

Stefani April 30th, 2008 07:35:00 PM

If anyone is interested, there are a few websites where you can watch spay and neuter procedures and learn about what's involved surgically:

http://tags.library.upenn.edu/tag/veterinary_video...
http://www.vetvideos.com/
http://old.cvm.msu.edu/courses/vm557/surgery/index...

Stefani, a ligature is just when you tie a loop of suture around a blood vessel or bit off tissue to stop blood flow through it. We were taught to tie two ligatures in each place where we were going to cut because it make it less likely the the site will bleed and gives you security against a ligature slipping off or one of the knots coming undone. So, you make one loop, knot it, cut your suture, then move a little bit away and make another loop, knot it, and cut it.

It's a bit of a balancing act between putting in enough knots and ligatures to prevent the site from bleeding and not putting in too much. Suture is considered a foreign body, and even though it's sterile, it can still cause irritation and infection until it gets absorbed. I suppose some vets only do one ligature because it's cheaper (since you use less suture) and it's faster (provided they don't start bleeding internally, of course).

Megan April 30th, 2008 07:42:00 PM

"Ligating (tying off) both ureters instead of the uterine horns. If you tie off both ureters, urine can't get out, and it results in kidney failure."

I had nightmares (literally!) about doing this before I did my first spay. Of course our professors would never let us make a mistake like that, but I didn't relax until our surgery dog went #1 and #2 post-op....

Megan April 30th, 2008 07:46:00 PM

Thanks, Megan! I love video instruction!

Dr. Patty Khuly April 30th, 2008 07:52:00 PM

Thanks Megan, for the info. It gets confusing in these documents, because sometimes they talk about ligating uterine horns and other times they use the word arteries or vessels and it's not clear to me what is expected. Other times they just talk about placing ligatures without saying where. Whatever it is, the ligating sounds really important.

Stefani April 30th, 2008 08:44:00 PM

I still have a question about spaying: What is preventing this procedure from being done endoscopically instead of full abdominal surgery?

I'm guessing that since dog and cat uteruses are V shaped, instead of pear shaped like ours, might have something to do with it. But what about just tying off/cauterizing the ovaries? What's the reason for this not being done, or commonly done if it's being done occasionally?

Sherri April 30th, 2008 09:35:00 PM

Sherri-
Cost is the main reason that most vets don't spay endoscopically. A good scope is a HUGE investment and a lot of training and practice is required. When my vet first started performing laproscopic spays, they took WAY longer than a routine surgical spay. Now he is quite proficient, but we charge more for this service to help pay for the scope.

Meghan RAHT April 30th, 2008 10:31:00 PM

My only peeve is vets who do spays/neuters without following up with an owner on other procedures that could be done at the same time to avoid subsequent anaesthesia etc. Examples I've seen just in the last week are: female lab with largish (more than thumb sized) inguinal hernia spayed and EVEN THOUGH OWNER ASKED hernia not repaired; male husky with large overdeveloped and loose rear dew claws and retained testicle neutered and owner told that (even though one had already been torn/injured) that it would be 'cruel' to remove the dew claws.

Whassup with that?Q

Janeen May 1st, 2008 12:21:00 AM

Great article. People wondered why I went out of my way and paid to have my dog neutered by MY vet when I could have had him neutered for "free" at the shelter where I adopted him.

Juli May 1st, 2008 12:55:00 AM

For me, I need to have Veterinary care I can afford - just like my medical care. So I can't do all the "bells and whistles" - for my pets or myself. But your post and particularly the photo you chose to accompany it does bring to mind a question: How is a client to know how many "bells and whistles" they are actually getting for their money? Of the Vet clinics I worked in, none performed spays/neuters like in the photo. One Vet I worked for used to smoke while performing surgery and I would literally have to brush cigarette ashes off the surgical patients sometimes. How would a client ever know this? In a human hospital, a patient assumes a standard of surgical care is practiced but what about in a Vet hospital? Can one reasonably assume that a $500 dog spay has more "bells and whistles" than a $150 spay?

slt May 1st, 2008 11:04:00 AM

Great comments from everyone. It was always my feeling that the two times you put 100% faith in clinics/vets for procedures well done are surgery/anesthesia and euthanasia. The latter has been permanently removed from my list---as of Oct. 18, 2006, thanks to a clinic in Dover, NH that has been violating state statutes for years, unpunished.

That said, I have only experienced one "botched" neuter 30+ years ago, post surgery infection that resolved with antibiotics & treatment.

I live in a state where there is a long-standing subsidized spay/neuter program in place that oddly is a 2 parter----one does not involve income requirements at all to qualify!!! It is my opinion that this program become dismantled and perhaps the low income qualifying program become easier to obtain (as a compromise). Still, the "bells and whistles" should be the same basic standard of service for both.

Barbara A. Albright/New Hampshire May 1st, 2008 11:35:00 AM

Thanks Meghan RAHT

Sherri May 1st, 2008 03:31:00 PM

slt: You have to ask...and trust...

Dr. Patty Khuly May 1st, 2008 09:35:00 PM

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