Risk Analysis Index and 30-Day Mortality after Brain Tumor Resection: A Multicenter Frailty Analysis of 31,776 Patients from 2012 to 2020

Abstract

Introduction: To evaluate the discriminative accuracy of the preoperative Risk Analysis Index (RAI) frailty score for prediction of mortality or transition to hospice within 30 days of brain tumor resection (BTR) in a large multi-center, international, prospective database. Methods: BTR patients were extracted from the American College of Surgeons-National Surgical Quality Improvement Program (2012-2020) database. The relationship between the RAI frailty scale and the primary endpoint (mortality or discharge to hospice within 30-days of surgery) were assessed by linear-by-linear proportional trend tests, logistic regression, and receiver operating characteristic curve (ROC) analysis (area under the curve as C-statistic). Results: Patients with BTR (N=31,776) were stratified by RAI frailty tier: 16,800 robust (52.8%), 7,646 normal (24.1%), 6,593 frail (20.7%), and 737 severely frail (2.3%). The mortality/hospice rate was 2.5% (n=803) and positively associated with increasing RAI tier: robust (0.9%), normal (3.3%), frail (4.6%), and severely frail (14.2%) (P<0.001). Isolated RAI was a robust discriminatory of primary endpoint in ROC analysis in the overall BTR cohort (C-statistic: 0.74, 95% CI: 0.72-0.76) as well as the malignant (C-statistic: 0.74, 95% CI: 0. 67-0.80) and benign tumor subsets (C-statistic: 0.71, 95% CI: 0.70-0.73) (all P<0.001). RAI score had statistically significantly better performance compared to mFI-5 and chronological age (both P<0.0001). Conclusions: RAI frailty score predicts 30-day mortality after BTR and may be translated to the bedside with a user-friendly calculator (https://nsgyfrailtyoutcomeslab.shinyapps.io/braintumormortalityRAIcalc/. The findings hope to augment the informed consent and surgical decision-making process in this patient population and provide an example for future study designs.

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

“…Previous studies within neurosurgery have also displayed the RAI-A’s superior discriminatory accuracy for predicting adverse outcomes when compared to mFI-5. 30 , 31 In addition, the mFI-5 is a unidimensional instrument that assesses frailty by using a limited subset of four comorbidities in conjunction with a measure of functional independence. The RAI-A, on the other hand, takes into account a total of five domains of frailty, including comorbidities, physical functionality, social variables, nutritional state, and a cognitive domain.…”