Feline onychectomy: Current practices and perceptions of veterinarians in Ontario, Canada

Abstract

The objective of the study was to determine the proportion of practitioners from Ontario, Canada who perform onychectomy, identify the techniques utilized, and obtain practitioners views on the procedure. An anonymous survey was distributed to Ontario Veterinary Medical Association members. Mann-Whitney U-tests were used to compare responses of opinion questions related to declawing between respondents who indicated they perform declawing procedures and those who do not. Of 500 respondents, 75.8% reported performing onychectomy, with 60.1% of those reporting performing the procedure less than monthly and 73.3% only performing the procedure after recommending alternatives. Statistically significant differences were found between those who do and those who do not perform onychectomy for perception of procedural pain, concept of mutilation, perception of procedural necessity for behavior modification or prevention of euthanasia, and support of province-wide procedural bans.

Introduction

Feline onychectomy, commonly referred to as declawing, is primarily an elective procedure that involves the removal of the third phalanx using a guillotine-type nail clipper, surgical blade, or laser (1,2). The most common reason for performing onychectomy is unwanted scratching behavior causing personal injury or property damage (1,3). Occasionally, the procedure is performed on 1 or more digits as part of treatment for traumatic injuries or immune-mediated disease. Because there is no medical benefit to the cat when the procedure is elective, performing the procedure has become increasingly controversial. The movement to ban the procedure in some jurisdictions is causing concern in a profession that has traditionally supported the procedure and requires a closer look at the benefits and risks. Some veterinarians consider elective onychectomy unethical and choose not to perform the procedure; instead they offer alternatives such as environmental and behavioral manipulation and non-surgical techniques such as plastic nail coverings (2,3). Other veterinarians feel that onychectomy is preferred over other possible negative consequences including euthanasia or abandonment. Conflicts within the profession about declawing are due in part to the numerous short- and long-term complications that have been attributed to the procedure (4). Many veterinarians feel that declawing involves a significant amount of pain, leading to concerns about appropriate anesthesia and analgesia (5). Other concerns include the belief that declawed cats are more likely to exhibit other behavioral problems including aggression, biting, and house soiling (3,6). It has also been suggested that onychectomy increases stress levels because it prevents cats from performing natural behaviors (3).

It is estimated there are approximately 10.2 million owned cats in Canada with approximately 35% of households owning a cat (7). The exact number of declawed cats in Canada and the number of onychectomy procedures performed are difficult to determine. In the United States, the American Veterinary Medical Association estimates that approximately 24.4% of owned cats are declawed (3). Other estimates of the number of declawed cats vary substantially. A survey given to cat owners through an online bulletin board found that 19.6% of owners reported having cats that were declawed (8) and results of a random telephone survey of 662 cat-owning households in Indiana reported that 45.1% of respondents indicated owning declawed cats (9). A more recent study found that approximately 21% of cats seen in veterinary hospitals near Raleigh, North Carolina were declawed (10). A survey of veterinary practices in Colorado reported a mean of 5.3 onychectomies performed for every 23.7 feline neuter surgeries (11), similar to the 27.6% of cats declawed simultaneously with neutering as reported by a private practice in New York (12). Responding veterinarians in Atlantic Canada reported a mean of 7.8 declaw procedures per month in 2001 (13). Although exact numbers are not clear, taken together, these studies suggest at least 20% of owned cats in the United States are declawed. What is not known, however, is what percentage of practicing veterinarians in Canada perform declaw procedures or the techniques they use.

The purpose of this study was to explore some of the unanswered questions about the procedure within Ontario. The specific study goals were to determine the current proportion of veterinarians in Ontario, Canada who perform onychectomy, what techniques they use, and to assess their views on the procedure.

Materials and methods

An anonymous online survey was created, in collaboration with the American Association of Feline Practitioners, to evaluate the attitudes and practices related to onychectomy procedures among veterinarians in Ontario, Canada. The survey was originally piloted by veterinarians in the Colorado Veterinary Medical Association, Veterinary Information Network (VIN), and faculty at Colorado State University and North Carolina State University, for assessment of clarity, and potentially missing or inappropriate response options. The final survey contained 33 questions. The survey was distributed via an e-mail invitation to Ontario Veterinary Medical Association members (n = 2800) from January 29, 2015 to March 15, 2015. Respondents who reported seeing feline patients for routine medical and surgical care were included in the analysis (n = 508). Respondents were asked about their personal behaviors related to onychectomy as well as those of their clinic. Participants who reported performing onychectomy procedures were asked several questions about their technique, equipment used, and perceived rate of complications. Those who reported they do not perform onychectomies were asked to indicate the reasons. All respondents were asked to identify any alternatives to onychectomy they offer to clients. Lastly, all participants were asked their opinions about a province-wide ban on onychectomy as well as general perceptions about the onychectomy procedure. For many of the questions, multiple answers were allowed.

Results

The online survey was answered by 508/2800 respondents (18.1% response rate). This is approximately 14.1% of the 3592 licensed veterinarians in Ontario. The 3592 veterinarians include those not currently in clinical practice and those who do not practice feline medicine. Therefore, although an exact percentage of the Ontario practitioners working with feline patients who responded to the survey is not known, it is estimated to be more than 15%.

Participants were asked if any veterinarian in their clinic performed onychectomy; 455/499 (91.2%) responded yes, 44/499 (8.8%) responded no. When asked if they personally perform onychectomy, 379/500 (75.8%) responded yes, and 121/500 (24.2%) responded no.

Those not personally performing onychectomy were asked to identify the primary reasons. Reasons identified by those responding (n = 108) included: against personal beliefs or ethics (73.1%), never learned the procedure (15.7%), no client demand for service (2.8%), prohibited by clinic policy (5.6%), prohibited by local or national laws (2.8%), and “other” (35.2%).

Discussion

Most respondents reported performing onychectomy and nearly half of those who indicated they do not perform the procedure themselves work in a clinic in which the procedure is performed. However, as survey participation was voluntary and online, self-selection, and online population biases may be reflected in these results. Women tend to be over-represented in VIN membership and in answering online surveys. How gender impacts attitudes toward onychectomy is unknown. How well the respondents represent the population of veterinarians working with cats is also unknown and is a limitation of the study.

Although most respondents reported performing the procedure, it is not frequently performed, with most respondents reported performing onychectomy less than once a month. The majority of practitioners, regardless of whether they perform onychectomy themselves, recommend a variety of alternative options with the most common being appropriate scratching devices and nail trimming. This study did not assess participant views on the effectiveness of these measures.

For those performing onychectomy, scalpel only technique was reported to be used always or often by most respondents. Current literature suggests that the laser technique is recommended for minimizing complications associated with onychectomy (14). However, cost of laser equipment and the learning curve for use may be why most veterinarians continue to use scalpel techniques.

There were significant differences in practitioners’ personal views about onychectomy between those who perform onychectomy and those who do not. Most respondents who do not perform onychectomy reported believing the procedure and postoperative recovery involves pain, while only about 25% of those who do perform the procedure reported the same beliefs. Similarly, opinions differed between those who do and not perform onychectomy on questions regarding whether onychectomy is viewed as a form of mutilation, if it is sometimes necessary for treatment of behavioral problems, or if it is a necessary alternative to euthanasia for some cats. To the authors’ knowledge, no other studies have examined veterinarians’ attitudes toward onychectomy to this degree.

Most respondents believe that the procedure causes at least a fair amount of pain, consistent with what is reported in the literature. Numerous short- and long-term complications have been attributed to onychectomy with hemorrhaging and pain being the most common early postoperative complications. Potential later complications include claw regrowth, chronic draining tracts, radial nerve paralysis secondary to tourniquet use, infection, wound dehiscence or incomplete healing, protrusion or loss of the second phalanx, tissue necrosis from improper bandage placement, development of palmigrade stance, chronic pain, and persistent lameness (9,15–19). Anecdotally, it has also been suggested that removal of the claws inhibits normal isometric exercise of the lumbar muscles during scratching, thus changing how the paw contacts the ground and leading to back pain (20). Furthermore, 1 study found abnormal gait, determined by force plate analysis, for at least 12 d after onychectomy (21). Despite nearly 5% of veterinarians reporting that little or no pain is associated with the procedure, less than 3% reported use of no pain control either before or after surgery.

Although onychectomy is performed by most of the respondents to this survey, there are many veterinarians who reported feeling strongly that this procedure is unethical and unnecessary. The lack of conclusive data on adverse long-term behavioral effects, short-term complications, and impact on cat welfare fuels debate on this topic. Responding veterinarians most commonly reported refusing to perform onychectomy on ethical grounds. Other reports suggest that onychectomy is not associated with adverse long-term behavioral effects and that short-term complications, particularly pain and hemorrhage, can be adequately controlled with proper surgical technique and use of analgesia (22). Another welfare argument against onychectomy is the potential adverse effects of depriving a cat of the use of its claws and the ability to engage in species-specific behaviors (e.g., scratching, grooming). This frustration of natural behaviors has been proposed as a cause of chronic stress (3). Those who support onychectomy point out that scratching behaviors are a leading reason for cat relinquishment (23, 24), and directly impact the number of cats euthanized in veterinary clinics and animal shelters due to behavior problems (25). Yet, even this point is contested, with some arguing that declawed cats are actually at an increased risk of relinquishment and euthanasia (26). The lack of data about cat populations, cat ownership and owner attitudes in Canada presents challenges when interpreting studies. The population of cats in Canada includes 10.2 million “owned” cats with an unknown additional number of “feral” cats (7). How many of these are truly feral versus free-roaming owned cats is difficult to assess (27–29). The reasons owners allow cats to roam are also not well-described, although personal beliefs about cat welfare, urine spraying, and destructive behaviors such as inappropriate scratching have been identified. Without adequate population data, it is difficult to accurately assess the risk of declawing on shelter relinquishments, euthanasia, or free-roaming cat populations. It is also difficult to assess the impact a ban on declawing would have on overall cat welfare.

To the best of the authors’ knowledge, there is no ban in place at any location in Canada, yet nearly 3% of veterinarians reported not performing the procedure because of local or national laws. While a ban is not supported by the Canadian Veterinary Medical Association (CVMA) (30), the Canadian Federation of Humane Societies (CFHS) (31), the American Animal Hospital Association (AAHA) (32), the American Veterinary Medical Association (AVMA) (33), or the Cat Fanciers’ Association (CFA) (34), these organizations publicize strong position statements that onychectomy should only be performed with careful consideration after alternative options have been explored. These statements may be misunderstood as laws by some veterinarians. For example, the CVMA position statement indicates it “strongly discourages onychectomy (declawing) of domestic cats for routine purposes. Surgical amputation of the partial digit prevents cats from expressing normal behaviors and causes pain. Veterinarians should inform clients of the potential negative consequences of declawing and educate them about tools and techniques available to prevent and minimize personal and property damage so that the procedure may be avoided” (30). Similarly, the CFHS position is “opposed to the declawing of cats, but reluctantly accepts declawing if it is the only alternative to having the cat euthanized. The CFHS believes it is the responsibility of cat owners to become educated on the subject of declawing and its alternatives. The declawing of cats should be a last resort when behavior modification has been ineffective and euthanasia or abandonment will result if the behavior does not cease” (31).

It is estimated that as many as 28 countries, including many European countries, have banned onychectomy (35) for welfare reasons, yet there have been no published studies on the potential welfare outcomes of these bans. Attitudes about cats and ownership in these countries may also be different than those in the United States and Canada. This study showed that 94.5% of respondents who perform onychectomy do so only after other alternatives have been offered, following the positions of multiple organizations. However, many individuals feel these policies do not go far enough and that a legislative ban is necessary. Despite the call from many to legislate a ban on onychectomy, the results of this study, and the position statements by key organizations, suggest that most veterinarians do not support a legislative ban. In this study, 32.5% of those who perform onychectomy (78.2% of the surveyed veterinarians) support a ban. And, although 81.2% of veterinarians who do not perform onychectomy support a ban, they comprise only 21.8% of the survey participants. A follow-up study to determine why veterinarians do or do not support a ban would provide additional useful information.

In summary, onychectomy is often an emotional and divisive topic and there are significant differences in opinions between those who perform the procedure and those who do not. Regardless of their position, many veterinarians feel passionately about the subject, as reflected in the numerous additional comments offered by respondents to the survey. While many veterinarians are strongly opposed to the procedure under any circumstances, results of this study suggest that most veterinarians do perform onychectomy, yet appear to do so only after offering or recommending numerous alternative options — following the guidelines of CVMA. It is interesting to note that despite the interest and controversy that surround onychectomy, there is a dearth of data to help guide the field forward. It is critical to have a better understanding of the number of declawed cats, as well as the impact onychectomy has on behaviors, quality of life, and relinquishment. As communities debate onychectomy bans, an analysis of the impact of the bans that have already been implemented could help political leaders make informed decisions. CVJ

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