Early spay/neuter procedure: Benefits must outweigh risks, DVMs say

COLUMBUS, OHIO — Although pediatric sterilization is not performed in most general practices, many veterinarians say shelter environments are the most plausible venue for the procedure.

Dr. Larry Hill, an Ohio State University professor, and assistants prepare a pediatric patient for a sterilization procedure at the Franklin County Dog Shelter in Columbus, Ohio. Hill says performing these procedures before animals are adopted from shelters is the only way to ensure 100-percent spay/neuter compliance.

In attempt to gain control of the companion-animal population, a group of Ohioans is attempting to make animal sterilization mandatory statewide. If this legislation were introduced, all canines leaving Ohio shelters would be altered before being placed in homes, now matter what the age.

The early-age spay/neuter procedure is not without its share of controversy due to fears of complications like female incontinence and anesthetic risks. Many shelters believe the necessity of curbing the animal overpopulation problem outweigh the procedure's risks.

"Anytime you use the word 'mandatory,' it adds stipulations that could complicate the adoption of an animal, particularly funding," says Jack Advent, CAE, executive director of the Ohio Veterinary Medical Association.

Kellie DiFrischia, co-director of the Columbus Dog Connection hopes veterinarians will speak on behalf of the proposal.

"Although this legislation will include all sterilization procedures, a big need lies with performing the pediatric spays and neuters before dogs can have litters and prolong the overpopulation problem," DiFrischia says.

Companion animal overpopulation is the main issue making the procedure a necessity before animals are placed in adoptive homes, officials contend. Depending on the region, many shelters report 50-percent compliance or worse.

The need to curb pet overpopulation spurred California's Davis Act, the only current statewide law that mandates animal rescues and shelters spay and neuter animals before they are released for adoption. The 1999 law might provide a platform to base the Ohio proposal.

The Ohio movement is in very early stages, and the initiating group says it plans to hold meetings with more politicians and veterinarians regarding the legislation.

"The reason behind this is obvious; we are euthanizing healthy adoptable dogs. Making the sterilization mandatory will eliminate a big part of the problem," Kilroy says. "The plan would also ultimately reduce taxpayer's money on euthanizing shelter animals."

But veterinarians, when asked by DVM Newsmagazine, say there isn't a need for general practitioners to offer pediatric gonadectomies before pets reach a more traditional age for the surgery. However, they agree with the need for shelter DVMs to perform the procedure.

The American Animal Hospital Association (AAHA) and the American Veterinary Medical Association (AVMA) support the practice of pediatric spay/neuter as a method to help reduce the overpopulation problem in dogs and cats. Recommendations for animal care and control facilities are as early as 8 weeks to 16 weeks of age.

AVMA's position statement on the prepubertal procedure includes the quote: "Just as for other veterinary medical and surgical procedures, veterinarians should use their best judgment in deciding at what age spay/neuter should be performed on individual animals."

Reasons including female dog incontinence, weight of the animal, the general age and anesthesia risks are given for not performing the procedure before the animal is at least 6-months-old, says Dr. Dan Beer, Care Pet Clinic, Columbus, Ohio.

While many DVMs say they support early spay/neuters in a shelter environment, they typically counsel clients to wait until 6 months of age to perform the procedure.

"Small animals like rabbits and ferrets are spayed and neutered all of the time," Beer says. "Some will never reach more than 2 pounds, yet the procedure is performed."

The protocol

The most common reason the procedure is performed is to eliminate the chance of an animal producing unwanted offspring.

"If an animal is healthy and weighs at least 5 pounds, I feel comfortable performing the procedure," says Dr. Evanne Thompson, Three Rivers Veterinary Hospital. "I am not concerned about female dogs becoming incontinent because of the procedure, and the benefits outweigh the risks."

Preferences are adjusted according to the practice and compliance rate among clients.

"The situation is entirely different when you are dealing with a general practice and a shelter," says Dr. Larry Hill, an OSU professor and Franklin County Animal Shelter. "If you have more control over the situation — such as a client-doctor relationship, you have no reason to push for early spaying and neutering. In a shelter, there is only about 50-percent compliance with bringing the animal back to perform a spay or neuter."

Dr. Gary Krone of Animal Clinic Northview in North Ridgeville, Ohio, says veterinarians at his practice do not perform spays or neuters before the animal has at least reached 5 months of age.

"There hasn't been a problem with the animals we have seen that had an early spay or neuter, but the procedures haven't been conducted long enough to really see if there are long-term problems, Krone says. "It is more tradition than anything keeping us from changing our ways."

Although veterinarians have leniency as to when recommending the procedure, harm to the animal should not be a factor in not performing the procedure, says Dr. Rachel Starr, Capital Area Humane Society in Columbus, Ohio.

Yet, not all veterinarians prescribe to an early spay/neuter protocol.

"If kittens are old enough to adopt, they are old enough to neuter, and puppies can be neutered at 8-weeks of age," Starr says. "We prefer kittens to weigh at least 3 pounds when they are spayed and female puppies to be at least 12-weeks-old.

"There really isn't the anesthesia risk that was once an issue," Starr says. "Performing a pediatric procedure is much safer now."

Medical benefit/potential downfalls

Medical benefits include reduction of cancer risks, less body fat equating to less bleeding, change in negative behaviors and faster recovery time.

"There are no apparent ill effects from the early spay and neuter," Hill argues. "There has been discussion regarding penile urethral diameter in cats at risk of blockage and female dog incontinence, but the benefits are greater than those risks."

Beer says there is no reason to put animals through a heat cycle before being spayed.

"People are busy and don't have time to bring the animal back to be altered," Beer adds. "And saying female dogs may become incontinent is wrong — thousands of Depends are sold, and people are not spayed or neutered."

"In our situation we want to make sure animals are spayed or neutered before leaving the building," Starr says. "They recover better when the surgery is performed at a younger age to a certain extent. The biggest reason for the procedure is to make sure we are not propelling the overpopulation problem by adopting pets to owners that may not comply with the animal being altered. Shelters are ground breaking out of necessity. If I were at a general practice, I might wait until the animal had its full set of vaccines, (at about 4-months of age) but in the shelter situation, the procedure works well."

A study published in the Journal of the American Veterinary Medical Association (JAVMA), Feb. 2004, reported results of dogs that underwent gonadectomy procedures from age 6 weeks to a year old — comparing early-age gonadectomy surgery outcomes to those of the traditional age.

One of the trials showed those puppies altered before 5.5 months of age, 6.7 percent developed hip dysplasia, whereas dogs undergoing the surgery at 6 months or older had a 4.7 percent rate of developing the condition. However, the dogs with hip dysplasia that had been altered at 5.5 months or older, were three times more likely to be euthanized for the condition than the dogs undergoing the procedure at an earlier age.

The results among female dogs, decreasing age at gonadectomy on a continuous scale was associated with increasing incidence of urinary incontinence that required medical treatment. Female puppies gonadectomized before 3 months of age appeared to be at highest risk compared to those spayed at more than 3 months of age.

Among male and female dogs altered before 5.5 months of age, the study showed an increase of hip dysplasia, noise phobias and sexual behaviors while obesity, separation anxiety, escaping behaviors, inappropriate elimination when frightened and relinquishment were decreased.

Conclusions of the study stated practitioners should consider recommending routine gonadectomy in client-owned male dogs before the traditional age of 6 months.

For female dogs, waiting until the dog is at least 3-months-old may be beneficial because of potential for urinary incontinence.

"What is most important when considering pediatric spays and neuters is not that general practitioners all begin performing them at 8 to 16 weeks of age," says Louise Murray, DVM, Dipl. ACVIM, director of Medicine at American Society for the Prevention of Cruelty to Animals (ASPCA). "It is important that they do not act adversely to shelters or veterinarians making the decision to perform them because of their reasons for doing so."