Brumund Lisa, Wittenberg-Voges Liza, Rohn Karl, Kästner Sabine B R
Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.
Institute for Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.
Front Vet Sci. 2024 May 23;11:1384525. doi: 10.3389/fvets.2024.1384525. eCollection 2024.
An accurate risk score that can predict peri-anesthetic morbidity and mortality in equine patients could improve peri-operative management, outcome and client communication.
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 ( ≤ 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.
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.
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.
一种能够预测马属动物围麻醉期发病率和死亡率的准确风险评分，可改善围手术期管理、预后并加强与客户的沟通。
300匹马接受了麻醉前风险评估，采用美国麻醉医师协会身体状况评分并结合马属动物特有疾病（ASA-PS-马属动物评分）、一个包含10个部分的多因素评分量表（10-RS）以及两者结合的马用麻醉风险识别与优化工具（CHARIOT）。记录全身麻醉后7天内的麻醉期间及麻醉后并发症、恢复阶段和死亡率。为比较这三种评分的效用和预测能力，使用二项逻辑回归（≤0.05）和受试者工作特征曲线分析对数据进行分析。此外，基于五例假设患者，分析了ASA-PS-马属动物评分和10-RS的观察者间可靠性、速度、安全性、易用性和表面效度。
所有评分均显示与麻醉期间的各种并发症及恢复阶段的参数存在统计学显著关联。与麻醉期间（AUC = 0.6093 - 0.6701）和麻醉后（AUC = 0.5373 - 0.6194）并发症发生相关的评分的判别能力仅为低水平。所有评分对总体死亡率的诊断准确性最高（AUC = 0.7526 - 0.7970），其中ASA-PS-马属动物评分的区分最为精确（AUC = 0.7970；95% CI 0.7199 - 0.8741）。10-RS的观察者间可靠性为中等（κ = 0.39），ASA-PS-马属动物评分为中等（κ = 0.52）。将患者分配到CHARIOT的过程大多被评为相当容易和快速或非常快速。
本研究的主要局限性在于单中心研究设计以及未能获得所有分数范围。总之，所有这三种评分都为预测接受全身麻醉的马属动物的死亡风险提供了有用信息，而这些评分无法预测麻醉期间及术后并发症。
