{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T04:36:45Z","timestamp":1790224605704,"version":"4.1.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T00:00:00Z","timestamp":1607385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Vet. Sci."],"abstract":"<jats:p>Euthanasia of companion animals in veterinary emergency medicine is a common cause of death. Euthanasia is economic when it is the consequence of the pet owner's inability to afford essential treatment while a viable medical alternative to euthanasia exists. Gastric dilatation-volvulus (GDV) is an acute life-threatening emergency condition of dogs; if left untreated, rapid death is highly likely. Surgical treatment leads to survival of around 80-90% of dogs; however, such treatment is costly. Therefore, pre-surgical euthanasia may be largely economically motivated. Having pet insurance, a financial instrument to reduce the burden of unforeseen veterinary medical costs on pet owners, would be expected to abolish the risk for pre-surgical economic euthanasia. We therefore aimed to determine whether pet insurance attenuates the risk of pre-surgical economic euthanasia in dogs with GDV. Non-referred dogs (<jats:italic>n<\/jats:italic> = 260) with GDV and known insurance status seen at 24 emergency clinics over a 2-year period were included. Relevant data (e.g., insurance status, age, comorbidities, outcome) were retrospectively extracted from a pet insurer's claim records (insured animals) or from electronic medical records of participating hospitals (non-insured animals). Forty-one percent of dogs (106 of 260 dogs) did not survive to hospital discharge; 82 (77%) of non-survivors died before surgery, all through euthanasia. The pre-surgical euthanasia rate was 10% in insured and 37% in non-insured dogs (<jats:italic>p<\/jats:italic> &amp;lt; 0.001). When adjusted for the effect of age, deposit size, comorbidities, and blood lactate concentration, the absence of insurance increased the odds of pre-surgical euthanasia by a factor of 7.4 (95% CI 2.0 to 37; <jats:italic>p<\/jats:italic> = 0.002). Of dogs undergoing surgery, 86% survived to hospital discharge. Overall, 80% of insured animals and 53% of non-insured animals survived to hospital discharge (<jats:italic>p<\/jats:italic> &amp;lt; 0.001). Thus, insurance was associated with a marked decrease in risk of pre-surgical euthanasia indicating that the cause of pre-surgical euthanasia of dogs with GDV is predominantly economic in nature. The rate of pre-surgical euthanasia in dogs with GDV may emerge as a suitable marker to quantify economic decision making of pet owners and to measure the impact of financial interventions aimed at mitigating economic duress associated with cost of veterinary emergency care.<\/jats:p>","DOI":"10.3389\/fvets.2020.590615","type":"journal-article","created":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T05:44:18Z","timestamp":1607406258000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":24,"title":["The Effect of Pet Insurance on Presurgical Euthanasia of Dogs With Gastric Dilatation-Volvulus: A Novel Approach to Quantifying Economic Euthanasia in Veterinary Emergency Medicine"],"prefix":"10.3389","volume":"7","author":[{"given":"Manuel","family":"Boller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tereza S.","family":"Nemanic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarryd D.","family":"Anthonisz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdoline","family":"Awad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Selinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise M.","family":"Boller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Stevenson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2020,12,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2115","DOI":"10.1111\/jvim.15315","article-title":"Ethical conflict and moral distress in veterinary practice: a survey of North American veterinarians","volume":"32","author":"Moses","year":"2018","journal-title":"J Vet Intern Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1136\/vr.103725","article-title":"Veterinarian's dilemma: A study of how Danish small animal practitioners handle financially limited clients","volume":"179","author":"Kondrup","year":"2016","journal-title":"Vet Rec"},{"key":"B3","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1080\/02682621.2018.1542571","article-title":"The euthanasia decision-making process: a qualitative exploration of bereaved companion animal owners","volume":"37","author":"Bussolari","year":"2018","journal-title":"Bereave Care"},{"key":"B4","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1037\/a0035837","article-title":"The distinct role of performing euthanasia on depression and suicide in veterinarians","volume":"19","author":"Tran","year":"2014","journal-title":"J Occup Health Psychol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1136\/vr.104619","article-title":"Ethical dilemmas encountered by small animal veterinarians: characterisation, responses, consequences and beliefs regarding euthanasia","volume":"182","author":"Kipperman","year":"2018","journal-title":"Vet Rec"},{"key":"B6","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.cvsm.2005.10.005","article-title":"Billing, third-party payment options, and pet health insurance","volume":"36","author":"Dunn","year":"2006","journal-title":"Vet Clin North Am Small Anim Pract"},{"key":"B7","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1053\/j.tcam.2014.09.007","article-title":"Cardiovascular and systemic effects of gastric dilatation and volvulus in dogs","volume":"29","author":"Sharp","year":"2014","journal-title":"Top Companion Anim Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1136\/inpract.31.2.66","article-title":"Gastric dilation-volvulus syndrome in dogs 1. 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