Anesthesia Complications Hit 10-12% of Dogs and Cats, Surgeon Says

Overall complication rates related to anesthesia run 10 to 12 percent in dogs and cats, with anesthetic deaths reported at less than 1 percent, according to board-certified surgeon Dr. Kendra Freeman, DVM, MS, DACVS. For brachycephalic breeds, the risk profile is dramatically higher: perianesthetic complications have been recorded in up to 49 percent of those patients.

Dr. Freeman, an associate surgeon in Albuquerque, N.Mex., who holds dual large-animal and small-animal certification from the American College of Veterinary Surgeons, lays out the numbers in a piece on communicating soft tissue surgery risks — and on translating them into conversations that hold up at the exam table and after discharge.

What changes at the consultation?

Clients now arrive armed with research drawn from search engines, social media groups, and AI tools. Dr. Freeman writes that pre-consultation research can enable a more comprehensive discussion when the client already has baseline knowledge of the condition. If the information came from less reliable sources, their understanding of the diagnosis and treatment recommendations may be unrealistic — and correcting that framing becomes part of the visit.

Diagnosis itself carries nuance. A cranial cruciate ligament (CCL) injury — a very common presentation in surgical referral practice — is straightforward to diagnose when the ligament is completely ruptured. Partial or incomplete tears are trickier. Dr. Freeman contrasts two signalments: a five-year-old Labrador retriever with a recent partial CCL injury versus a 10-year-old Labrador with bilateral chronic cruciate injuries and radiographic evidence of osteoarthritis. Same diagnosis category, different prognoses, different surgical recommendations, different recoveries.

"These are the intricacies and nuances about complex surgical cases that cannot be learned in a weekend course, wet lab, or lecture, but are critical to recognize," she writes.

How should surgical options be framed?

Sometimes one surgical option exists; sometimes several do. Dr. Freeman urges veterinarians to present the most reasonable options with their advantages, disadvantages, and limitations — not just cost and travel time.

Her examples span general and specialty practice:

• Traditional ovariohysterectomy versus ovariectomy versus ovarian-sparing spay in general practice.
• Extracapsular stabilization offered in-clinic versus tibial plateau leveling osteotomy (TPLO) or tibial tuberosity advancement from a traveling specialist or referral hospital.
• Total hip arthroplasty versus femoral head and neck excision for hip dysplasia.

She advises against passing judgment on which option a client will pick: "I'm often surprised by which clients are interested in a total hip arthroplasty for hip dysplasia and which clients elect femoral head and neck excision."

Is age the right risk question?

The age question comes up constantly in surgical consultations. Dr. Freeman reframes it around frailty rather than chronological age — frailty being a state of limited body reserve and increased vulnerability to external stressors. Clinicians can assess it through activity tolerance, body condition, mobility, and muscle mass.

A geriatric patient at a healthy weight with reasonable mobility and minimal comorbidities can be a good anesthetic and surgical candidate. A geriatric patient with recent unintentional weight loss, poor muscle mass, and decreased energy requires a different conversation — not exclusion from surgery, but potentially additional treatments, diagnostics, medication selection, and perioperative care.

What does recovery compliance actually look like?

Recovery length varies by procedure: an uncomplicated cystotomy heals on a far shorter timeline than a TPLO. In her practice, Dr. Freeman reports two consistent points of contention — the Elizabethan collar and activity restriction. After TPLO she asks for eight weeks of strict activity restriction, with leash walks starting two weeks postoperatively, and troubleshoots expected challenges before surgery.

Even so, she writes, despite a detailed consultation, written expectations, and a discharge review, a client recently called two days after a TPLO to report the dog was feeling great — and to ask whether it could have free access to the house and yard.

Incisional complications include inflammation, infection, seroma formation, and dehiscence. Surgeons mitigate risk through healthy-tissue incisions, appropriate tissue handling, and suture selection. Clients carry responsibility too, and Dr. Freeman's hospital has increased compliance by offering at-home alternatives to the rigid plastic cone, including surgical suits and inflatable collars.

The anesthetic data she cites draws on a 1999 JAAHA study of complications and mortality in dogs and cats, a 2018 JAVMA study of anesthesia-related complications in brachycephalic dogs, and 2020 work on canine aging and frailty. Her closing argument is structural: dedicated consultation time before the procedure builds trust, and well-informed clients recognize normal postoperative changes earlier, flag concerns sooner, and follow discharge instructions more consistently — improving patient outcomes across the surgical caseload.