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

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 inj...

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Published in:Neurospine Vol. 19; no. 4; pp. 1039 - 1048
Main Authors: Conlon, Matthew, Thommen, Rachel, Kazim, Syed Faraz, Dicpinigaitis, Alis J., Schmidt, Meic H., McKee, Rohini G., Bowers, Christian A.
Format: Journal Article
Language:English
Published: Korea (South) Korean Spinal Neurosurgery Society 01.12.2022
Subjects:
frailty
modified frailty index
Original
risk analysis index-administrative
risk analysis index-revised
spinal trauma
Frailty
Risk Analysis Index-administrative
Spinal trauma
Modified frailty index
Risk Analysis Index-revised
ISSN:2586-6583, 2586-6591
Online Access:Get full text
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Summary: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.
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Matthew Conlon and Rachel Thommen contributed equally to this study as cofirst authors.
ISSN:2586-6583
2586-6591
DOI:10.14245/ns.2244326.163