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. 2024 Jun;21(2):404-413.
doi: 10.14245/ns.2347120.560. Epub 2024 Jun 30.

Baseline Frailty Measured by the Risk Analysis Index and 30-Day Mortality After Surgery for Spinal Malignancy: Analysis of a Prospective Registry (2011-2020)

Rachel Thommen  1   2 , Christian A Bowers  2 , Aaron C Segura  2 , Joanna M Roy  3 , Meic H Schmidt  2
Affiliations

Baseline Frailty Measured by the Risk Analysis Index and 30-Day Mortality After Surgery for Spinal Malignancy: Analysis of a Prospective Registry (2011-2020)

Rachel Thommen et al. Neurospine. 2024 Jun.

Abstract

Objective: To evaluate the prognostic utility of baseline frailty, measured by the Risk Analysis Index (RAI), for prediction of postoperative mortality among patients with spinal malignancy (SM) undergoing resection.

Methods: SM surgery cases were queried from the American College of Surgeons - National Surgical Quality Improvement Program database (2011-2020). The relationship between preoperative RAI frailty score and increasing rate of primary endpoint (mortality or discharge to hospice within 30 days, "mortality/hospice") were assessed. Discriminatory accuracy was assessed by computation of C-statistics (with 95% confidence interval [CI]) in receiver operating characteristic (ROC) curve analysis.

Results: A total of 2,235 cases were stratified by RAI score: 0-20, 22.7%; 21-30, 11.9%; 31-40, 54.7%; and ≥ 41, 10.7%. The rate of mortality/hospice was 6.5%, which increased linearly with increasing RAI score (p < 0.001). RAI was also associated with increasing rates of major complication, extended length of stay, and nonhome discharge (all p < 0.05). The RAI demonstrated acceptable discriminatory accuracy for prediction of primary endpoint (C-statistic, 0.717; 95% CI, 0.697-0.735). In pairwise ROC comparison, RAI demonstrated superiority versus modified frailty index-5 and chronological age (p < 0.001).

Conclusion: Preoperative frailty, as measured by RAI, is a robust predictor of mortality/ hospice after SM surgery. The frailty score may be applied in clinical settings using a user-friendly calculator, deployed here: https://nsgyfrailtyoutcomeslab.shinyapps.io/spinalMalignancyRAI/.

Keywords: Frailty; Metastatic; National Surgical Quality Improvement Program; Risk Analysis Index; Spinal oncology; Spinal tumor.

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Conflict of interest statement

Conflict of Interest

In order to comply with the Hospital Participation Agreement (HPA) that is agreed to between the ACS and participating sites, facility identifiers as well as geographic information regarding the case have been removed. The HPA stipulates that the ACS does not identify participating sites. Site identification could be possible even with blinded identifiers through advanced statistics. A stipulation of access to the PUF is completion of the Data Use Agreement that strictly prohibits attempts to identify hospitals, health care providers, or patients. The authors have nothing to disclose.

Figures

Fig. 1.
Fig. 1.
Incidence rate of mortality within 30 days of operation stratified by preoperative RAI frailty score, ACS-NSQIP 2011-2020 (N=2,235). RAI, Risk Analysis Index; ACS-NSQIP, American College of Surgeons – National Surgical Quality Improvement Program.
Fig. 2.
Fig. 2.
Risk Analysis Index (RAI) with superior discriminatory accuracy for primary endpoint of 30-day mortality compared to age and mFI-5 (DeLong pairwise comparison, p < 0.001), ACS-NSQIP, 2011–2020 (N=2,235). ACS-NSQIP, American College of Surgeons – National Surgical Quality Improvement Program; mFI-5, modified frailty index-5; CI, confidence interval.
Fig. 3.
Fig. 3.
Postoperative outcomes stratified by RAI frailty tier, ACS-NSQIP 2011–2020 (N=2,235). RAI, Risk Analysis Index; ACS-NSQIP, American College of Surgeons – National Surgical Quality Improvement Program.
See this image and copyright information in PMC

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