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Frontiers in veterinary science2024; 11; 1384525; doi: 10.3389/fvets.2024.1384525

Risk assessment in equine anesthesia: a first evaluation of the usability, utility and predictivity of the two-part CHARIOT.

Abstract: An accurate risk score that can predict peri-anesthetic morbidity and mortality in equine patients could improve peri-operative management, outcome and client communication. Unassigned: Three hunded horses underwent pre-anesthetic risk assessment using the American Society of Anesthesiologists-Physical Status augmented with equine-specific diseases (ASA-PS-Equine), a multifactorial 10-part rubric risk scale (10-RS), and a combination of both, the Combined horse anesthetic risk identification and optimization tool (CHARIOT). Intra-and post-anesthetic complications, the recovery phase and mortality were recorded over a period of 7 days following general anesthesia. To compare the utility and predictive power of the 3 scores, data were analyzed using binominal logistic regression (p ≤ 0.05) and receiver operating characteristic curve analysis. In addition, inter-observer reliability, speed, safety, ease of use and face validity of the ASA-PS-Equine and the 10-RS were analyzed based on five hypothetical patients. Unassigned: All scores showed statistically significant associations with various intra-anesthetic complications and parameters of the recovery phase. The discriminant ability of the scores related to the occurrence of intra-anesthetic (AUC = 0.6093-0.6701) and post-anesthetic (AUC = 0.5373-0.6194) complications was only low. The highest diagnostic accuracy for all scores was observed for overall mortality (AUC = 0.7526-0.7970), with the ASA-PS-Equine differentiating most precisely (AUC = 0.7970; 95% CI 0.7199-0.8741). Inter-observer reliability was fair for the 10-RS (κ = 0.39) and moderate for the ASA-PS-Equine (κ = 0.52). Patient assignment to the CHARIOT was predominantly rated as rather easy and quick or very quick. Unassigned: The main limitations of the study are the monocentric study design and failure to obtain the full range of points. In conclusion, all 3 scores provide useful information for predicting the mortality risk of equine patients undergoing general anesthesia, whereas intra-and postoperative complications cannot be predicted with these scores.
Copyright © 2024 Brumund, Wittenberg-Voges, Rohn and Kästner.
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Publication Date: 2024-05-23 PubMed ID: 38846780PubMed Central: PMC11155666DOI: 10.3389/fvets.2024.1384525Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research investigates the usability and predictive power of three risk assessment scores—ASA-PS-Equine, 10-RS, and CHARIOT—in equine anesthesia to predict peri-anesthetic morbidity and mortality. Their findings indicate all three scores can provide useful information for predicting mortality risk yet struggle to forecast intra- and postoperative complications.

Research Methodology

  • The research was conducted on 300 horses undergoing pre-anesthetic risk assessment through three scoring techniques – the American Society of Anesthesiologists-Physical Status boosted with equine-specific diseases (ASA-PS-Equine), a 10-part multifactorial rubric risk scale (10-RS), and a combination of both known as the Combined horse anesthetic risk identification and optimization tool (CHARIOT).
  • Intra- and post-anesthetic complications, the recovery phase, and mortality were recorded for seven days after general anesthesia.
  • The data was analyzed for utility and predictive power of the three scores using binomial logistic regression and receiver operating characteristic (ROC) curve analysis.
  • The team assessed inter-observer reliability, speed, safety, usability, and face validity for ASA-PS-Equine and 10-RS using five hypothetical patients.

Findings

  • The research found statistically significant connections between all scores and various intra-anesthetic complications as well as recovery phase parameters.
  • The discriminant capacity of the scores regarding the incidence of intra- and post-anesthetic complications was deemed low (with AUC ranging from 0.6093-0.6701 for intra-anesthetic and 0.5373-0.6194 for post-anesthetic complications).
  • However, the scores specifically showed the highest diagnostic accuracy for overall mortality (with AUC = 0.7526-0.7970). The ASA-PS-Equine score differentiated most precisely (AUC = 0.7970 and 95% CI 0.7199-0.8741).
  • Between the two, the ASA-PS-Equine had a better inter-observer reliability (κ = 0.52) than the 10-RS with κ = 0.39.
  • Patient assignment to the CHARIOT was primarily rated as rather easy, fast or very fast.

Conclusions and Limitations

  • The research concluded that all three scores can contribute valuable information for predicting equine patients’ mortality risk under general anesthesia. However, they do not effectively predict intra- and postoperative complications.
  • Nonetheless, the study’s results are limited due to its monocentric design and the inability to secure the entire range of points.

Cite This Article

APA
Brumund L, Wittenberg-Voges L, Rohn K, Kästner SBR. (2024). Risk assessment in equine anesthesia: a first evaluation of the usability, utility and predictivity of the two-part CHARIOT. Front Vet Sci, 11, 1384525. https://doi.org/10.3389/fvets.2024.1384525

Publication

Frontiers in veterinary science
ISSN: 2297-1769
NlmUniqueID: 101666658
Country: Switzerland
Language: English
Volume: 11
Pages: 1384525

Researcher Affiliations

Brumund, Lisa
  • Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.
Wittenberg-Voges, Liza
  • Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.
Rohn, Karl
  • Institute for Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.
Kästner, Sabine B R
  • Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

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Citations

This article has been cited 2 times.
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