Bewertung des Anästhesierisikos beim Hund mithilfe eines multifaktoriellen Risikoindex: der LeiV-Risk-Index

Zusammenfassung

Gegenstand und Ziel Der Leipziger Veterinärmedizinische Risiko-Index kurz „LeiV-Risk-Index“ ist ein multifaktorieller Index, der zur objektiven und präzisen Bewertung des Anästhesierisikos beim Hund entwickelt wurde. Er basiert auf 10 Risikokriterien, welche die perioperative Mortalität beeinflussen. Ziel dieser Studie war eine Evaluierung der Anwendung des LeiV-Risk-Index und seiner Risikokriterien und ein direkter Vergleich mit der ASA-Klassifikation.

Material und Methoden Im Rahmen einer deutschlandweiten Online-Umfrage unter in der Kleintiermedizin tätigen Tierärzten wurde die Anwendung des LeiV-Risk-Index untersucht. Die Teilnehmer erhielten allgemeine Fragen zu ihrem beruflichen Hintergrund und der praktischen Anwendung des LeiV-Risk-Index. Zudem sollten sie 15 hypothetische Patienten mithilfe des LeiV-Risk-Index und der ASA-Klassifikation bewerten. Als Maß für die Übereinstimmung der Bewertung wurde ein Fleiss‘-Kappa bestimmt. Zudem wurde der Zusammenhang des LeiV-Risk-Index zur ASA-Klassifikation mittels eines Korrelationskoeffizienten untersucht.

Ergebnisse Die Übereinstimmung aller vergebenen LeiV-Risikoklassen zwischen den Teilnehmern war deutlich (κ = 0,55) und weitaus höher als bei Klassifizierung mittels ASA-Klassifikation (κ = 0,33). Es wurden im Schnitt für einen Patienten 3 verschiedene LeiV-Risikoklassen und 4 verschiedene ASA-Klassen vergeben. Zudem ließ sich eine positive Korrelation zwischen LeiV-Risikoklasse und steigender ASA-Klasse nachweisen. Es konnte kein signifikanter Einfluss vom Geschlecht des Anwenders, Sicherheit in der Anwendung des LeiV-Risk-Index oder klinischer Erfahrung auf die Höhe der vergebenen LeiV-Risikoklassen nachgewiesen werden.

Schlussfolgerung und klinische Relevanz Mit dem LeiV-Risk-Index steht in der Tiermedizin erstmals ein Index zur Bewertung des Anästhesierisikos zur Verfügung, der auf objektiven Risikokriterien basiert und dessen Objektivität die der ASA-Klassifizierung übertrifft. Anästhesiepatienten können somit auch in der Veterinärmedizin übereinstimmender bewertet werden. Auch Anwendung und Praktikabilität des LeiV-Risk-Index wurden von 95 % der Teilnehmer positiv aufgenommen. Eine weitere Überarbeitung einzelner Risikokriterien muss überdacht werden.

Abstract

Objective The Leipzig Veterinary Risk-Index – “LeiV-Risk-Index” is a multifactorial risk index developed to enable an improved objective assessment of the anesthetic risk in dogs. The scoring system is based on 10 risk factors affecting perioperative mortality. The aim of this study was to evaluate the applicability of the LeiV-Risk-Index and its risk factors as well as to perform a direct comparison with the ASA-classification.

Material and methods An online survey was conducted among veterinarians working in small animal medicine throughout Germany. Participants received a questionnaire containing information on 15 selected patients. They were asked to classify the patients according to the LeiV-Risk-Index and ASA-classification and to answer several questions concerning their professional background. The results were statistically analyzed considering the consistency among veterinarians of rating the different patients by using Fleiss’-Kappa. The correlation of LeiV-Risk-Index and ASA-classification was calculated.

Results The consistency of all assigned LeiV-risk classes between participants was moderate (κ = 0.55) and higher than classification by ASA (κ = 0.33). On average, 3 different LeiV-risk classes and 4 different ASA-classes were assigned for one patient. There was a positive correlation between LeiV-risk class and increasing ASA-class. No effect of gender or clinical experience of the veterinarian could be demonstrated on ranking patients. There was also no effect of how confident veterinarians felt in applying the LeiV-Risk-Index.

Conclusion und clinical relevance The LeiV-Risk-Index is the first index available in veterinary medicine for assessing anesthetic risk that is based on objective risk criteria and whose objectivity exceeds that of the ASA classification. Anesthetic patients can thus be evaluated more consistently in veterinary medicine as well. Utility and practicability were positively received by 95 % of the participants. Further revision of individual risk criteria needs to be reconsidered.

Schlüsselwörter

Anästhesie - perioperative Mortalität - Subjektivität - Checkliste - ASA-Klassifikation

Key words

Anesthesia - perioperative mortality - subjectivity - checklist - ASA-classification

Publication History

Received: 10 June 2021

Accepted: 11 January 2021

Article published online:
14 June 2022

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