Preoperative risk assessment in horses: agreement and predictive value of CHARIOT (Combined Horse Anaesthetic Risk Identification and Optimisation Tool).

CHARIOT and ASA-PS both predict 7-day postoperative mortality in horses; multicentre validation needed.

This prospective observational pilot study evaluated the Combined Horse Anaesthetic Risk Identification and Optimisation Tool (CHARIOT) in 50 client-owned horses, comparing its interobserver agreement and predictive value with the American Society of Anesthesiologists Physical Status (ASA-PS) classification. Five evaluator groups with varying expertise levels (interns, residents, specialists, and diplomates) assessed each horse preoperatively. Mixed-effects Poisson regression and logistic regression analyses revealed significant differences between anaesthesia experts and other evaluator groups, with experts assigning higher risk scores using both systems. Critically, both CHARIOT and ASA-PS scores demonstrated strong associations with 7-day postoperative mortality (p < 0.001). CHARIOT scores ranged from 12.7-13.9 across groups, while ASA-PS scores ranged from 1.8-2.0. The findings suggest CHARIOT may provide valuable predictive information for postoperative outcomes in equine patients. However, the authors acknowledge limitations and recommend multicentre studies to validate CHARIOT's clinical utility and establish standardized application protocols across different expertise levels.

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