If you’ve ever owned a male cat, you’ll know that vets recommend most should be castrated. For various reasons including preventing unwanted pregnancies in female cats, slowing the spread of infectious disease, and reducing roaming, castration is almost always beneficial for male cats. Vets perform cat castrates every day, and some may even argue it is a ‘minor surgery’. Is this the case? Are cat castrates that simple? Can the procedure ever be complicated?
What Makes a Surgery ‘Major’ or ‘Minor’?
First, we should define what makes a surgery minor or major. And you may be surprised to hear that there isn’t an official answer from any human or animal medical organisation. The definition may vary doctor to doctor, surgery to surgery, and even patient to patient. There have even been queries and studies for over 100 years trying to officially define the terms, with no luck.
A US doctor in 1917 contacted the Annals of Surgery journal asking for the term to be defined, as it affected what sort of surgery osteopaths could perform. The answer he received listed various factors that make a surgery major, such as: needing a general anaesthetic; opening the ‘great cavities’; those with high risk of bleeding; those with high risk of death; those requiring ‘special anatomical knowledge and manipulative skill’. These are all quite vague and subjective per surgeon, so not especially helpful.
A survey of US surgeons was taken in 1965, asking them their opinion of what makes a surgery ‘major’. Together, they identified variables such as: mortality rate, amount of trauma, the equipment, training and assistants required; the length of operation. These variables were slightly better than the Annals of Surgery’s answer in 1917, but did not account for individual patient factors and changes in technology since then. A similar survey in 2020 of surgeons from the European Surgical Association (ESA) came up with similar variables, but did include some patient factors like underlying illness. All of the other variables remained quite subjective and variable per patient even in the same type of surgery.
The lack of definition is not just a linguistic problem
Some medical boards require their trainee surgeons to have completed various ‘major’ surgeries to qualify, yet does not outline what these are. Thousands of medical papers, articles and conversations discuss major and minor surgeries, with presumably much variation on what they mean. And all of these discrepancies means that when a doctor or vet discusses surgery with a client, they may not have the right idea of whether their surgery truly is major or not.
What this also means is that it will be hard for us to truly determine whether a cat castrate is minor or not, given the lack of official definition from any veterinary body. Thus, we will have to fall into the same pitfalls as the previous examples and use common factors like length of surgery, patient status, skill required, and so on. This means the answer may be variable depending on which vet you ask.
How Is a Cat Castration Performed?
Let’s briefly outline the steps to perform a routine cat castration, though all the steps may vary surgeon to surgeon.
First, the cat is examined to confirm it is healthy, male, has both testicles descended, and can be castrated. This involves a clinical exam. Some vets may also check their blood parameters as well. They are then give an anaesthetic and pain relief, usually via intravenous or intramuscular injection with a variety of different drugs. Once induced, some vets will place an endotracheal tube into their trachea to provide oxygenation and inhaled anaesthetic drugs.
The castration site is then clipped of hair and sterilised. Some vets may apply local anaesthetic at this stage too. The surgeon sterilises their hands at the same time. The scrotum’s skin and inner vaginal tunic is cut with a scalpel blade to expose the testicles. The testicular cord and vessels are ligated either with suture material or by tying the vessels to each other (autoligation). The open scrotal skin can be closed with suture material, surgical glue, or left open to heal naturally.
Most will go home with pain relief, either injected before discharge or given orally at home. Depending on the cat, they may have to wear a buster collar or pet shirt to cover the wound. Many vets advise a recheck in a few days to ensure the wound is healing properly. Normally, in 7-10 days, the cat is back to normal life.
Why is a Cat Castration seen as a Minor Procedure?
In this author’s opinion, a cat castration can be considered a minor operation in the majority of cases.
Starting with surgeon factors, the procedure is technically simple provided there is good understanding of the cat’s anatomy, with little surgical skill needed – in fact, it is often one of the first procedures that veterinary students are taught to perform.
When we consider the surgery itself, the procedure is generally short, taking around 5 minutes to perform and another 10-20 to prepare for. It does not involve direct entry into a major body cavity, and usually has a low risk of bleeding. An assistant is rarely required beyond an anaesthetist. The complication rates are also very low – the RCVS performed a national audit in 2023 of over 10,000 cat castrates, of which around 7000 had a follow-up. Of these 7000, over 95% reported no abnormalities following surgery. Of the remaining 4.3%, over half required no treatment for their complications, and mortality was 0.08%. These rates are better than the rates for dog castration, and if we use the criteria from the ESA survey, major surgery has a morbidity >30% and mortality >2%, both of which a cat castration does not meet.
Considering patient factors, the majority of patients are young and healthy and, although a young age may increase the risk of anaesthetic complications such as hypothermia, the majority do very well and recover quickly. Very few will have underlying disease due to their age, and many vets will require the patient to be healthy before going ahead with a castration anyway.
When Could a Cat Castration Be Considered a Major Procedure?
It is important to note that any surgery can be major, even if the majority are minor. This includes cat castrates. This may be known before the surgery, or change during or after the surgery. Although the majority of cat castrates are simple, a vet should never be nonchalant about the possible risks, and treat every patient with care.
Pre-operatively, a cat castrate may be considered major if the patient is unwell, elderly or the procedure non-routine. Although most cats are castrated early, some may be done later in life where underlying illness like kidney, liver or heart disease are more common – admittedly, though most surgeons would probably elect to not perform this procedure on these cats, there may be select times when it is needed. Some cats may also be castrated during more complex surgeries to avoid second anaesthetic too. In rare cases, cat testicles may not fully descend into the scrotum, and instead reside anywhere in the abdominal cavity or inguinal region – removal of these retained testicles can be technically more complicated, involve entry into the abdomen, and increased risk of complications.
During the surgery, issues can arise with the anaesthetic that may complicate it. These may be lack of respiration, oxygenation, the anaesthetic being too shallow or deep, or even the heart stopping – these are rare, thankfully, but can occur in any patient. The surgery itself may also become major if there is a lot of bleeding, more common in larger and older cats, or those with underlying clotting issues.
Final Thoughts
In summary, if we consider the non-official variables put forward by various medical boards and surgeons, then a routine cat castrate performed at a young age on a health animal can be considered a minor surgery. This does not mean there are not risks involved, and it could progress to a major surgery unexpectedly. Your vet should discuss all these risks with you before the procedure takes place. Nevertheless, from the evidence available, cat castrates are generally a safe procedure with low morbidity and mortality rates, and brings benefits far exceeding these minor risks.
Further Reading
Annals of Medicine and Surgery (lww.com)
NASAN Benchmark Report 2023 – RCVS Knowledge
Should I neuter my cat, and what are the benefits?
Discussion