Preoperative Frailty Measured by the Clinical Risk Analysis Index (RAI-C) and Outcomes After Spinal Tumor Surgery: A Single Center Prospective Surgical Series

Introduction: Surgeons are frequently faced with challenging clinical dilemmas evaluating whether the benefits of surgery outweigh the substantial risks routinely encountered with spinal tumor surgery. The Clinical Risk Analysis Index (RAI-C) is a robust frailty measure administered via patient-friendly questionnaire that strives to augment preoperative risk stratification. To prospectively measure frailty with RAIC and track postoperative outcomes after spinal tumor surgery. To prospectively measure frailty with RAI-C and track postoperative outcomes after spinal tumor surgery.

Methods: Patients surgically treated for spinal tumors were followed prospectively from 7/2020-7/2022 at a single tertiary center. RAI-C was ascertained during preoperative visits and verified by the provider. RAI-C was analyzed against outcome of unfavorable functional status (modified Rankin Scale score > 2, mRS>2) at follow-up.

Results: Of 39 patients, 47% were robust (RAI 0-20), 26% normal (21- 30), 16% frail (31-40), and 11% severely frail (RAI 41+). RAI-C had a positive association with mRS>2 at follow-up: 16% for robust, 20% for
normal, 43% frail, and 67% for severely frail. The two deaths in the series had the highest RAI-C scores (45 and 46) and were patients with metastatic cancer. One of those mortalities possessed a 5-factor modified frailty index of 0 (=not frail), highlighting the limitations of comorbidity exclusive indices. RAI-C was a robust and diagnostically accurate predictor of mRS>2 in receiver operating characteristic curve analysis (C-statistic: 0.70, 95 CI: 0.49-0.90).

Conclusion : The findings exemplify the clinical utility of RAI-C frailty scoring for prediction of outcomes after spinal tumor surgery and its potential to be a significant factor in the surgical decision-making process to provide truly informed surgical consent.