Frailty measured by risk analysis index and adverse discharge outcomes after adult spine deformity surgery: analysis of 3104 patients from a prospective surgical registry (2011–2020)

Covell, Michael M.; Rumalla, Kavelin; Kassicieh, Alexander J.; Segura, Aaron; Kazim, Syed Faraz; Schmidt, Meic H.; Bowers, Christian A.

doi:10.1016/j.spinee.2022.12.014

Cited by 8 publications

(2 citation statements)

References 32 publications

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“…The revised RAI is a validated, quantitatively robust, frailty metric that has demonstrated superior discrimination across multiple neurosurgical subspecialties [ 15 - 18 ]. The RAI offers utility with its user-friendly calculation, which can be used at the point of care in clinical applications alongside large database studies.…”

Section: Methodsmentioning

confidence: 99%

A Predictive Model of Failure to Rescue After Thoracolumbar Fusion

Roy,

Segura,

Rumalla

et al. 2023

Neurospine

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Objective: Although failure to rescue (FTR) has been utilized as a quality-improvement metric in several surgical specialties, its current utilization in spine surgery is limited. Our study aims to identify the patient characteristics that are independent predictors of FTR among thoracolumbar fusion (TLF) patients.Methods: Patients who underwent TLF were identified using relevant diagnostic and procedural codes from the National Surgical Quality Improvement Program (NSQIP) database from 2011–2020. Frailty was assessed using the risk analysis index (RAI). FTR was defined as death, within 30 days, following a major complication. Univariate and multivariable analyses were used to compare baseline characteristics and early postoperative sequelae across FTR and non-FTR cohorts. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory accuracy of the frailty-driven predictive model for FTR.Results: The study cohort (N = 15,749) had a median age of 66 years (interquartile range, 15 years). Increasing frailty, as measured by the RAI, was associated with an increased likelihood of FTR: odds ratio (95% confidence interval [CI]) is RAI 21–25, 1.3 [0.8–2.2]; RAI 26–30, 4.0 [2.4–6.6]; RAI 31–35, 7.0 [3.8–12.7]; RAI 36–40, 10.0 [4.9–20.2]; RAI 41– 45, 21.5 [9.1–50.6]; RAI ≥ 46, 45.8 [14.8–141.5]. The frailty-driven predictive model for FTR demonstrated outstanding discriminatory accuracy (C-statistic = 0.92; CI, 0.89–0.95).Conclusion: Baseline frailty, as stratified by type of postoperative complication, predicts FTR with outstanding discriminatory accuracy in TLF patients. This frailty-driven model may inform patients and clinicians of FTR risk following TLF and help guide postoperative care after a major complication.

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Section: Methodsmentioning

confidence: 99%

A Predictive Model of Failure to Rescue After Thoracolumbar Fusion

Roy,

Segura,

Rumalla

et al. 2023

Neurospine

Self Cite

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“…6,[11][12][13][14] It underscores the importance of using frailty assessment tools that are appropriate for the context and have been rigorously validated, such as the Risk Analysis Index, which has shown strong discriminatory accuracy in predicting surgical outcomes across various age groups. [15][16][17] The authors also present a brief comparison of frailty scores based on the 10 core principles defined in Table 4 that offers comparison for these tools. 6 However, a more comprehensive exposition is warranted, and a balanced comparison of the limitations inherent in both Risk Analysis Index and HFRS and other alternate risk scores should be undertaken to attain consensus within the field for a tool with most accurate predictability and better utilization across practice settings for risk-stratification and intervention decisions of our patients.…”

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confidence: 99%