Colic is one of the most frequent reasons for emergency equine veterinary consultations in first opinion practice, with around 25% of cases requiring hospital admission. It is a major healthcare concern for horse owners and is one of the most common causes of equine morbidity and mortality. As veterinary professionals, it is important that we can use available evidence to inform owners about colic prevention and management, including the potential need for surgical intervention and likely outcomes following surgery.  It is also important to use this information when making evidence-based decisions around veterinary care of the horse with colic. This lecture will cover the following: Common myths and challenges around communicating colic risk with horse owners; Identifying and managing the at-risk horse; Evidence-based approaches to veterinary diagnosis and management; Surgical outcomes based on the findings of the International Colic Surgery Audit (INCISE); Surgical procedures to reduce colic recurrence.