Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis

Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury

“…Frailty in spine trauma outcomes is a new topic, with only 2 previously published studies on the topic, utilizing mFI scores [ 15 , 16 ]. RAI-A, a recently developed frailty index, and its recalibrated version, RAI-Rev, have not previously been evaluated in TSI patients, however RAI has recently been reported to possess superior predictive ability in spine procedures and brain tumor resection patients [ 22 , 23 ]. RAI-based frailty scores comprise a 14-item scoring system as compared to mFI-5 which is based on 5 items, and additionally the 14 items in RAI are more relevant to functional status of the patient as compared to mFI scores, and are thus both conceptually and mathematically superior to mFI [ 20 , 33 ].…”

“…The analyzed medical comorbidities included diabetes mellitus, COPD, CHF, dyspnea, hypertension, disseminated cancer (defined as multiple metastases by NSQIP), open wound, steroid use, weight loss (substantial unintentional weight loss > 10%), bleeding disorders, preoperative transfusion, transfer status, and preoperative sepsis/septic shock/systemic inflammatory response (SIRS). Preoperative SIRS criteria are defined by NSQIP as the presence of at least 2 of the following criteria: temperature > 38°C or < 36°C, heart rate > 90 beats per minute, respiratory rate > 20 breaths per minute or PaCO 2 < 32 mmHg, leukocytosis or leukopenia (white blood cell count > 12,000/mm 3 and < 4,000/mm 3 , respectively) or > 10% immature (band) forms, or anion gap acidosis [ 23 , 29 ]. Additional preoperative comorbidities extracted included functional dependence (both complete and partial dependence) and smoking status.…”

“…This frailty index including both the prospective clinical RAI and the retrospective administrative RAI (RAI-A) could be easily calculated from variables captured by the Veterans Affairs Surgical Quality Improvement Program and the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) databases includes both comorbidities and functional status variables that robustly measures baseline frailty status, and has recently been validated in a prospective, single-center spine surgery study, 22 and also by us in brain tumor resection patients. 23 Since its development the RAI has demonstrated significant utility in predicting 30-, 180-, and 365-day postoperative outcomes across multiple surgical subspecialties. 20,21,[24][25][26][27][28] Recently, Arya et al 24 have recalibrated and improved the original RAI (RAI-Rev) in order to better discriminate 30-day mortality and morbidity.…”

“…Preoperative SIRS criteria are defined by NSQIP as the presence of at least 2 of the following criteria: temperature > 38°C or < 36°C, heart rate > 90 beats per minute, respiratory rate > 20 breaths per minute or PaCO2 < 32 mmHg, leukocytosis or leukopenia (white blood cell count > 12,000/mm 3 and < 4,000/ mm 3 , respectively) or > 10% immature (band) forms, or anion gap acidosis. 23,29 Additional preoperative comorbidities extracted included functional dependence (both complete and partial dependence) and smoking status.…”

“…To more precisely incorporate the multifactorial nature of frailty, Hall et al [ 20 , 21 ] developed the Risk Analysis Index (RAI) in 2017 in an effort to provide an effective screening tool to assess the frailty of surgical patients. This frailty index including both the prospective clinical RAI and the retrospective administrative RAI (RAI-A) could be easily calculated from variables captured by the Veterans Affairs Surgical Quality Improvement Program and the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) databases includes both comorbidities and functional status variables that robustly measures baseline frailty status, and has recently been validated in a prospective, single-center spine surgery study [ 22 ], and also by us in brain tumor resection patients [ 23 ]. Since its development the RAI has demonstrated significant utility in predicting 30-, 180-, and 365-day postoperative outcomes across multiple surgical subspecialties [ 20 , 21 , 24 - 28 ].…”