Otero Balda et al: Prognostic factors for short‐term survival of cats that experienced postattenuation neurologic signs after surgical attenuation of single congenital portosystemic shunts
Veterinary Surgery 5, 2025

🔍 Key Findings

78% of cats that developed postattenuation neurologic signs (PANS) after congenital portosystemic shunt (cPSS) surgery survived to 30 days.
Postattenuation seizures (PAS) were associated with significantly decreased 30-day survival (50% vs. 78%; OR: 0.015, p = .005).
Treatment of PANS with propofol was a negative prognostic factor (OR: 0.112, p = .0008).
Generalized PAS accounted for most seizure cases and were more frequently fatal than focal or unknown-type seizures.
Pretreatment with levetiracetam (LEV1 protocol) showed a trend toward improved survival (100% vs. 60.6% in untreated cats), though not statistically significant (p = .06).
Shunt morphology, method of attenuation, and study period (early vs. late) were not significantly associated with 30-day survival.
Electrolyte, glucose, and ammonia abnormalities were not strongly linked to survival outcomes in this study.
Majority of PAS-related deaths were due to uncontrolled generalized seizures or euthanasia because of severity.

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Otero Balda et al: Prognostic factors for short‐term survival of cats that experienced postattenuation neurologic signs after surgical attenuation of single congenital portosystemic shunts
Veterinary Surgery 5, 2025

🔍 Key Findings

78% of cats that developed postattenuation neurologic signs (PANS) after congenital portosystemic shunt (cPSS) surgery survived to 30 days.
Postattenuation seizures (PAS) were associated with significantly decreased 30-day survival (50% vs. 78%; OR: 0.015, p = .005).
Treatment of PANS with propofol was a negative prognostic factor (OR: 0.112, p = .0008).
Generalized PAS accounted for most seizure cases and were more frequently fatal than focal or unknown-type seizures.
Pretreatment with levetiracetam (LEV1 protocol) showed a trend toward improved survival (100% vs. 60.6% in untreated cats), though not statistically significant (p = .06).
Shunt morphology, method of attenuation, and study period (early vs. late) were not significantly associated with 30-day survival.
Electrolyte, glucose, and ammonia abnormalities were not strongly linked to survival outcomes in this study.
Majority of PAS-related deaths were due to uncontrolled generalized seizures or euthanasia because of severity.

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Multiple Choice Questions on this study

In Otero Balda 2025 et al., on Short-term outcomes after feline cPSS surgery, which clinical variable was associated with the **lowest** odds of 30-day survival?

A. Development of non-seizure PANS

B. Treatment with levetiracetam

C. Treatment with propofol

D. Shunt location (intrahepatic)

E. Use of thin film banding

Answer: Treatment with propofol

Explanation: Propofol use was a negative prognostic factor (OR 0.112, p = .0008), likely reflecting more severe disease.

In Otero Balda 2025 et al., on Short-term outcomes after feline cPSS surgery, what was the 30-day survival rate in cats that developed postattenuation neurologic signs (PANS) after surgical attenuation of a single congenital portosystemic shunt?

A. 46%

B. 50%

C. 60%

D. 78%

E. 90%

Answer: 78%

Explanation: The study reported a 30-day survival rate of 78% in PANS-affected cats.

In Otero Balda 2025 et al., on Short-term outcomes after feline cPSS surgery, what was the survival rate in cats pretreated with levetiracetam following the LEV1 protocol?

A. 60.6%

B. 70.0%

C. 88.9%

D. 94.4%

E. 100.0%

Answer: 100.0%

Explanation: Cats in LEV1 group had a 100% 30-day survival rate, although the difference was not statistically significant.

In Otero Balda 2025 et al., on Short-term outcomes after feline cPSS surgery, which of the following was **not** significantly associated with 30-day survival in PANS-affected cats?

A. Shunt morphology

B. Treatment with propofol

C. Presence of generalized PAS

D. Postoperative development of seizures

E. Non-seizure neurologic signs

Answer: Shunt morphology

Explanation: Shunt type (extrahepatic vs. intrahepatic) was not significantly linked to 30-day survival in this study.

In Otero Balda 2025 et al., on Short-term outcomes after feline cPSS surgery, what proportion of cats with postattenuation seizures (PAS) survived to 30 days?

A. 25%

B. 33%

C. 50%

D. 67%

E. 80%

Answer: 50%

Explanation: Only half of the cats that developed PAS survived 30 days, compared to 78% overall.

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