The Fine Line Between Simplicity and Oversimplification: Comparing the Risk Analysis Index and 5-Factor Modified Frailty Index as Frailty Assessment Tools

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

“…2 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 RAI utilizes a multifactorial approach by incorporating domains such as comorbidities, functional status, cognition, and nutritional status.…”

“…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. As a more comprehensive frailty evaluation, it is not surprising that RAI showed better discrimination than mFI-5 in predicting postoperative poor outcomes.…”

Frailty Predicts 30-day mortality following major complications in neurosurgery patients: The risk analysis index has superior discrimination compared to modified frailty index-5 and increasing patient age

“… 8 , 9 , 10 , 13 , 15 Frail patients have increased rates of mortality, postoperative complications, and are more likely to be discharged to facilities with capacity for providing higher-level of care. 8 , 9 , 16 While a plethora of information about perioperative risk assessment exists, 8 , 9 , 10 , 13 , 17 , 18 and there is agreement about the presence of frailty as a syndrome, divergence of opinion still exists regarding its domains and the most appropriate strategy for accurately identifying and risk stratifying patients. 18 , 19 …”

“… 8 , 9 , 16 While a plethora of information about perioperative risk assessment exists, 8 , 9 , 10 , 13 , 17 , 18 and there is agreement about the presence of frailty as a syndrome, divergence of opinion still exists regarding its domains and the most appropriate strategy for accurately identifying and risk stratifying patients. 18 , 19 …”

“… 20 , 21 Nonetheless, its utility is limited because it stratifies patients based on only two frailty domains. 18 , 22 This approach may be underestimating, or otherwise excluding pertinent information. The risk analysis index (RAI) is an 11-variable weighted metric that was designed to better elucidate preoperative risk strata.…”