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

Abstract

Objective: To assess the discriminative ability of the Risk Analysis Index-administrative (RAI-A) and its recalibrated version (RAI-Rev), compared to the 5-factor modified frailty index (mFI-5), in predicting postoperative outcomes in patients undergoing surgical intervention for traumatic spine injuries (TSIs).Methods: The Current Procedural Terminology (CPT) and International Classification of Disease-9 (ICD-9) and ICD-10 codes were used to identify patients ≥ 18 years who underwent surgical intervention for TSI from National Surgical Quality Improvement Program (ACS-NSQIP) database 2015–2019 (n = 6,571). Multivariate analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the comparative discriminative ability of RAI-Rev, RAI-A, and mFI-5 for 30-day postoperative outcomes.Results: Multivariate regression analysis showed that with all 3 frailty scores, increasing frailty tiers resulted in worse postoperative outcomes, and patients identified as frail and severely frail using RAI-Rev and RAI-A had the highest odds of poor outcomes. In the ROC curve/C-statistics analysis for prediction of 30-day mortality and morbidity, both RAI-Rev and RAI-A outperformed mFI-5, and for many outcomes, RAI-Rev showed better discriminative performance compared to RAI-A, including mortality (p = 0.0043, DeLong test), extended length of stay (p = 0.0042), readmission (p < 0.0001), reoperation (p = 0.0175), and nonhome discharge (p < 0.0001).Conclusion: Both RAI-Rev and RAI-A performed better than mFI-5, and RAI-Rev was superior to RAI-A in predicting postoperative mortality and morbidity in TSI patients. RAI-based frailty indices can be used in preoperative risk assessment of spinal trauma patients.

The risk analysis index demonstrates exceptional discrimination in predicting frailty's impact on neurosurgical length of stay quality metrics

“…In concordance with findings in the surgical literature for a range of neurosurgical outcomes, we expected that RAI would have a greater discriminative threshold in these patients, and therefore compared it to mFI‐5 20,22,45 . The RAI utilizes a multifactorial approach by incorporating domains such as comorbidities, functional status, cognition, and nutritional status 45 . While the mFI‐5 takes into account comorbidities and functional status using a binary scale, it does not take into account other crucial aspects of frailty.…”

“…A preponderance of neurosurgical research has employed the mFI‐5 and mFI‐11 23,44,45 . In concordance with findings in the surgical literature for a range of neurosurgical outcomes, we expected that RAI would have a greater discriminative threshold in these patients, and therefore compared it to mFI‐5 20,22,45 .…”

The modified 5-item frailty index as a predictor of complications in burn patients

“…To calculate mFI-5, the following comorbidities were considered: hypertension requiring medication, chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus, and totally or partially dependent functional health status ( Table 1 ). Consistent with previous literature, 15 , 16 , 17 the mFI-5 score was calculated by dividing the sum of all positive variables by the total number of input variables in the database, with a higher mFI-5 score indicating a higher degree of frailty. This research was approved by the Ethics Committee of Hannover Medical.…”

Letter: Frailty-Based Prehabilitation for Patients Undergoing Intracranial Meningioma Resection

“…RAI has proven to be a better predictor of outcomes after surgery and could be a more useful tool during prehabilitation measures. 16…”

“…RAI has proven to be a better predictor of outcomes after surgery and could be a more useful tool during prehabilitation measures. 16 A recent study by our group has shown RAI's robust predictive ability for brain tumor resection outcomes including IMR, 6 thus raising the possibility of using RAI-based prehabilitaion for IMR patients. Emphasizing on preoperative rehabilitation measures for IMR could improve a patient's physiological reserve and reduce postoperative adverse events.…”