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Simple Summary Surgical sterilisation is a component of free-roaming dog population management programmes worldwide. However, evidence of the population-level impacts of sterilisation are rarely reported in peer-reviewed literature. Using a priority setting partnership process, we identified the most important unanswered questions concerning these impacts from the perspective of those working with free-roaming dogs. We found that there were many uncertainties surrounding the impacts of such programmes, and how they can be achieved. The top 10 priorities were related to changes in dog population dynamics; risks to human health; human perception and behaviour towards dogs; and logistics related to implementation in the field. Addressing these priorities will enable a more comprehensive understanding of if, how, and why canine surgical sterilisation programmes impact on free-roaming dog populations. Abstract Surgical sterilisation is a core activity of free-roaming dog population management (DPM) programmes globally. However, there is limited published evidence on its impact at the population level. To support evidence-based decision making in this field, it is important that research conducted is relevant to those involved in working with free-roaming dogs and implementing such programmes. The aim of this study was to adapt the James Lind Alliance (JLA) user involvement approach to systematically identify the top 10 research priorities regarding the impact of canine sterilisation. International stakeholders with experience working in DPM were asked in an online survey what unanswered questions they had regarding the impact of sterilisation programmes. Thematic analysis of survey responses was used to develop a long list of collated indicative research questions (CIRQs). A literature review was performed to identify questions that were ‘true uncertainties’ (had not been answered by evidence review). These questions were reduced to a shortlist via an online interim prioritisation survey, and a Delphi consensus process determined the top 10 priorities. The top 10 questions related to dog population size and turnover, dog bite incidents, rabies control, implementation in the field and human behaviour change. These priorities were identified and shaped by people with direct experience of canine surgical sterilisation programmes, and as such are an essential resource for directing future funding and research. Addressing these priorities will generate evidence that is directly applicable to policy makers and practitioners who make decisions regarding the management of free-roaming dogs (FRDs) worldwide.

This is an updated version of a clinical decision making article originally published in Vet Record in June 2018.7 #### Bottom line Dr Perry brings her five-month-old female domestic shorthair kitten, Kylie, in to be spayed. She has read on the internet that cats can be spayed using either a midline or a flank incision. She is very concerned about Kylie being in pain and asks you which is the least painful surgical option for Kylie. You wonder if one approach is less painful than the other. In \[female cats that are being neutered] does [a midline approach compared with a flank approach\] \[decrease pain following surgery\]? The search strategy can be viewed at https://bestbetsforvets.org/bet/567, and it is also available as a supplement to this article on Vet Record ’s website at https://veterinaryrecord.bmj.com/content/186/17/565 ### Supplementary data [vetrecm2008supp001.docx] Search last performed: 24 April 2020 Only five of the six papers identified were evaluated for this evidence summary. Coe et al 1 contains the same data set as Grint et al , …

Current recommendations for the elimination of canine-mediated human rabies focus on mass dog vaccination as the most feasible and cost-effective strategy. However, attempts to control rabies are often combined with canine surgical sterilisation programmes. The added value of sterilisation is widely debated. A systematic review was undertaken to compare the outcomes and impact of vaccination and sterilisation programmes with vaccination only programmes. A systematic search of three electronic databases (CAB Abstracts, Medline and Global Health) and grey literature was performed. From 8696 abstracts found, 5554 unique studies were identified, and 16 studies met the inclusion criteria. Eight described vaccination only programmes and eight described vaccination and sterilisation programmes. Indicators of impact measured were dog bites and/or doses of post-exposure prophylaxis administered; numbers of dog and/or human rabies cases; dog population demographic changes; changes in health and welfare of dogs, and indicators related to human behaviour change. The studies were contextually very diverse, programmes being implemented were complex, and there was variation in measurement and reporting of key indicators. Therefore, it was difficult to compare the two types of intervention, and impossible to make an evaluation of the role of sterilisation, using this evidence. Given the large number of vaccination and sterilisation programmes conducted globally, the lack of studies available for review highlights a gap in data collection or reporting, essential for impact assessment. There are several knowledge gaps concerning the impact of the sterilisation component alone, as well as subsequent effects on rabies transmission and control. Prospective studies comparing the outcomes and impact of the two interventions would be required in order to establish any additional contribution of sterilisation, as well as the underlying mechanisms driving any changes. In the absence of such evidence, the priority for rabies control objectives should be implementation of mass vaccination, as currently recommended by the World Health Organisation., Author summary Rabies is an important viral zoonosis that causes approximately 59,000 human deaths every year. The vast majority of cases result from a bite from an infected dog. Annual vaccination of at least 70% of the dog population is recommended for elimination of canine rabies. Canine surgical sterilisation programmes are sometimes conducted alongside rabies vaccination. However the contribution of sterilisation to rabies control, above that of the vaccination alone, is controversial. This systematic review compared the outcomes and impacts of vaccination and sterilisation programmes with vaccination only programmes. Sixteen studies met the study’s formal inclusion criteria, however we were unable to answer the question using this evidence and the role of sterilisation remains unclear. We identify gaps in knowledge regarding the implementation and impact of the sterilisation component as well as any resulting effects on rabies transmission and control. Prospective studies evaluating the two types of intervention would provide comparative evidence, which is needed to enable informed decisions to be made regarding whether sterilisation should be conducted for the purposes of canine rabies control.

Dr Perry brings her five-month-old female domestic shorthaired kitten, Kylie, in to be spayed. She has read on the internet that cats can be spayed either using the midline or flank approach. She is very concerned about Kylie being in pain and asks you which is the least painful surgical option for Kylie. You wonder if one is less painful than the other. In \[female cats that are being neutered] does [a midline approach compared to a flank approach\] \[decrease pain following surgery\]? The search strategy can be viewed at http://bestbetsforvets.org/bet/459, and it is also available as a supplement to this article on Vet Record’s website at http://veterinaryrecord.bmj.com/content/182/24/694 ### Supplementary file 1 [SP1.docx] Search last performed: 19 December, 2017 Only four papers are listed in the summary of evidence as one paper (Coe RJ, Grint NJ, Tivers MS, et al . Comparison of flank and midline approaches to the ovariohysterectomy of cats. Vet Rec 2006;159:309–13) contains the same data set as Grint and others2, and this paper was selected for the BET as it was more relevant. Midline v flank incisions for cat spays – is one more painful than the other? Paper 1: Prospective evaluation of postoperative pain in cats undergoing ovariohysterectomy by a midline or flank approach1 Patient group: Twenty female cats undergoing ovariohysterectomy. Study type: Randomised controlled trial. Outcomes: Pain was assessed using a modified version of the Cambridge SDS (simple descriptive scale) score system. It was assessed …