Risk Analysis Index Outperforms the Modified Frailty Index-Five Following Anterior Cervical Discectomy and Fusion
Cameron Sabet1, Bhav Jain2, Bara Hammadeh3, Stefan Prulovic1, Weaam Masoud4
1Georgetown University Medical Center, 2Stanford Medicine, 3Al-Balqa' Applied University, 4King Hussein Cancer Center
Objective:
To compare the modified Frailty Index-5 (mFI-5) and Risk Analysis Index (RAI) in predicting postoperative outcomes.
Background:
Anterior cervical spine surgery carries significant morbidity, especially in older adults. Frailty assessment may improve preoperative risk stratification beyond traditional models.
Design/Methods:
We performed a retrospective cohort study using ACS-NSQIP data (2015–2021) of 59,674 patients undergoing anterior cervical procedures. Frailty was assessed using mFI-5 and RAI. Multivariable logistic regression adjusted for demographics and operative factors. Model performance was evaluated with AUROC and the DeLong test, with bootstrap validation.
Results:
Thirty-day mortality was 0.13%. RAI demonstrated superior discrimination compared to mFI-5 for mortality (AUROC 0.810 vs 0.708, p=0.0003), major complications (0.692 vs 0.637, p<0.0001), and non-home discharge (0.779 vs 0.658, p<0.0001). Both indices remained significant predictors after adjustment.
Conclusions:
RAI for postoperative outcomes following anterior cervical spine surgery had superior predictive ability when compared with the mFI-5, with superior discrimination for mortality, major complications, and non-home discharge. These findings suggest that RAI has the promise for superior preoperative risk stratification for clinicians, potentially facilitating superior identification among high-risk patients, superior perioperative management tailoring, and superior resource allocation. Surgical planning with RAI would potentially facilitate improved patient counseling, support for shared decision-making, and potentially reduced postoperative adverse event rates among the medically complex and the aged.
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