15/10/2021
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Veterinary Services: The REAL Story (Part III)
While the reactions to the ABC article have died down, and many may even have forgotten its content, we promised to bring you Part III of this behind the scenes look at veterinary services, so: here it is!
In Part II we discussed why the costs of emergency services and general practices differ. Today, we will share the true cost of the most common procedure we perform: desexing a female dog.
The reality is, that veterinary clinics heavily discount the price of desexing as a public service. If we were to charge what we really *should* be charging for this procedure, no one would ever desex their pets! Desexing is of course about population control, but it also carries multiple health benefits, and from a medical point of view, it is definitely recommended for all dogs and cats.
Despite how we frequently we perform them, a spey procedure (desexing of a female animal) is a highly invasive and technically difficult surgery, that carries significant risk. The fact that very very few of these surgeries result in complications is testament to the training and skill of your veterinarian.
A spey involves using a scalpel blade to make an incision in the belly through the skin, muscle layers, and body wall to enter the abdomen. The uterus must then be located, which isn’t always easy as it is often hiding amongst the intestines and other organs! The canine and feline uterus has two ‘horns’, that is, it is shaped like a long Y, with ovaries at the ends of the horns, attached to the kidneys. The blood supply to the ovaries is substantial, and in order to remove the uterus and ovaries together, this blood supply must be clamped and tied off with supreme accuracy.
Once the ovaries are located, gentle traction must be applied in order to break their connection to the kidneys. This must be done very very carefully so that only the ligament in this connection is broken, and not the large blood vessels. If these large fragile vessels are torn, the abdomen will very quickly fill with blood, and the patient is at risk of rapid death.
When this connection is broken, the vessels are then clamped, and suture material is used to tie the vessels closed. These knots must be perfect, as the blood pressure in these vessels combined with excessive activity post operatively, can cause the knots to slip off, and these vessels to bleed into the abdomen. When we are happy with our ties, we cut through the tissues and hope that our knots are secure and that when we release the vessels, they don’t disappear into the abdomen and begin to bleed. Even for very experienced vets, this is the most nerve wracking and dangerous part of this procedure.
When both of the ovaries have been disconnected from their tissues in the body, a similar process of clamping and tying is repeated near the cervix. In this region, the uterus resembles a tube of tissue, and depending on the size of the dog may be anything from approximately 5mm to a couple of centimetres in diameter. Either side of this tube are very large vessels, themselves several millimetres wide, that must be successfully tied off, often with separate and additional ties. The uterus is then cut above these ties, and the whole organ is removed from the body. Your dog has just had a hysterectomy! In humans, this would lay them up in hospital for days and days!
Once the uterus has been removed, we then suture the body wall closed, then the muscle layer, then the skin. It is again vital that our suturing and our knots are perfect. If they come undone, our patient’s organs can literally fall out of their body.
Throughout this procedure, which may take anywhere from 20 minutes in a tiny dog to a couple of hours in a big, old, fat dog, there will be a highly skilled nurse monitoring the anaesthetic and checking and recording vital signs the entire time. The patient will be receiving constant intravenous fluids, pain relief, anaesthetic gas, and oxygen. They will usually have multiparameter monitoring connected, including body temperature, blood pressure, blood oxygenation and carbon dioxide, heart rate, respiratory rate, and ECG. They will be lying on a heated surgical table, in a clean operating theatre, and the vet and nurse will be wearing scrub caps and masks, with the vet also wearing sterile surgical gloves and often a sterile surgical gown as well.
When the procedure is finished, the patient will be placed in a warm heated cage with a nurse monitoring their recovery and ensuring their pain is well controlled. During recovery, they will receive a different kind of pain relief, adding to the one they had previously. When they are awake and ready to get up, they will be taken outside for a wee walk, and offered a small amount to drink, and maybe a small snack. They will be discharged in the afternoon with pain relief to go home with for several days, and during the discharge appointment, the surgical nurse will discuss all the ins and outs of post operative care with the doggo’s owner.
Of course, our clients only see the clipped belly and a neat incision. But as you can see, what goes on in that belly to get to that point is actually a really big deal!
In terms of difficulty and the potential for complications, a spey is actually one of the more difficult surgeries that general practice vets perform.
So: let’s take a look at the costs involved. Most desexings are billed as one or two items, with an item by item breakdown not included. Let’s think about the costs that actually go into a spey.
A typical spey for a 20kg dog involves:
- Hospital fee for the day (cage cleaning, washing blankets, food, water, nurse time, overheads of cost of cages, overheads of building eg electricity, rent, rates etc)
- Pre medications - usually two different drugs (cost of drugs, syringes, needles, vet and nurse time)
- Anaesthetic injections, anaesthetic gas, IV catheter, breathing tube, anaesthetic machine use for the procedure, nurse and vet time
- IV fluids and drip line, IV pump use, nurse and vet time
- Monitoring equipment (use of machine, nurse time)
- Sterile surgical kit (cost to purchase, cost to clean and sterilise after every procedure, cost to buy disposable drapes or launder cotton drapes, nurse time)
- Cost of consumable items such as swabs, suture material, scalpel blades, syringes, needles, tape, surgical prep solutions, gloves, masks
- Maintenance and purchase costs of clippers, surgical table, heating apparatus, surgical light, theatre suite
- Vet surgical time
- Nurse time during procedure and recovery
- Additional medications post op (cost of medications, needles, syringes, vet and nurse time)
- Nurse time when discharging patient
- Next day follow up phone call (nurse time)
- 3-4 day post op check at no charge to client (nurse or vet time)
- 10-12 day suture removal at no cost to client (nurse or vet time)
With all that goes into a spey, how much do you think this procedure might actually cost the clinic?
If this was a similar surgery, say, an exploratory laparotomy, we would bill it out as line items. An exploratory laparotomy is similar to a spey in that we open the abdomen, and have a look around - we might remove an object from the intestines or stomach, take a biopsy of an organ, or remove a tumour. The equipment, medications, monitoring, and nurse attention are all very similar. A procedure such as this would likely result in the animal remaining in hospital for 24 hours or so, and this of course would add to the bill.
Now, using average fees to the client, let’s break down that spey procedure as we would for an exploratory laparotomy:
- Hospital Day Fee $60
- IV catheter & Intravenous Fluids $150
- Premedications $55
- Anaesthesia Induction $40
- Anaesthesia maintenance $280
- Anaesthesia nurse monitoring $50
- Surgical time per 10 minutes x4. $300
- Theatre fee $50
- Consumables $45
- Post op pain relief $45
- Elizabethan collar $25
- Nurse discharge appointment $0
- Post op check $0
- Suture removal $0
————> Total fee: $1100
Most clinics charge their clients *less than half* of this for a medium sized dog spey.
So how much does this procedure cost the clinic? Well, most clinics break even with desexings. For some, the procedure actually costs the clinic more than the client pays.
It must be said that ‘low-cost, high volume’ clinics cannot afford to provide the same level of care as that of the average general practice, so for them, the cost to the clinic of performing the spey, and therefore the cost to the client, is less.
So, as we can see, even though it is routine, a spey is by no means an easy or cheap surgery, and veterinary clinics make very little profit, if any, from desexing our furry friends.
We hope you’ve learned something from our behind the scenes series, now, over to you! For Part IV, we would like YOU to choose the topic! Simply comment below to tell us what you would like to know about vets and veterinary services, and next week we will discuss some of your questions!
