Predictive value of the risk analysis index for 30-day mortality following surgical management of thoracolumbar vertebral body fractures.

PURPOSE: Frailty has emerged as a key predictor of postoperative outcomes, with indices like the revised Risk Analysis Index (RAI) and the modified Frailty Index (mFI-5) used for assessment. The purpose of this study was to compare the predictive value and discriminatory accuracy of the mFI-5 and RAI for adverse outcomes following surgical management of thoracolumbar (TL) spine fractures.

METHODS

This was a retrospective cohort study utilizing data from the 2015-2019 years of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients were categorized using the RAI and mFI-5 frailty indices. The primary outcome was 30-day mortality and secondary outcomes included non-home discharge, extended hospital stays, and postoperative complications. Logistic regression was used to analyze the predictive value of frailty and discriminatory accuracy was assessed using receiver operating curve analysis.

RESULTS

There were 42,230 patients (median age = 64 years) included in this study. Increasing frailty was a significant predictor of greater odds for 30-day mortality. The RAI demonstrated superior discriminatory accuracy for 30-day mortality (C-statistic = 0.82) compared to both mFI-5 (C-statistic = 0.63) and age alone (C-statistic = 0.66).

CONCLUSION

The RAI is a more effective tool than the mFI-5 and age alone for preoperative frailty-based risk stratification in TL fracture patients, particularly in predicting 30-day mortality. Incorporating the RAI into clinical practice may improve preoperative informed consent, surgical candidate selection, and patient outcomes.