Resident Physician University of New Mexico Albuquerque, NM, US
Disclosure(s):
Kavelin Rumalla, MD, MS: No financial relationships to disclose
Introduction: The Risk Analysis Index (RAI) is a novel metric validated for robust measurement of frailty in surgical populations. However, the RAI has yet to be externally validated for use with ICD-10 driven administrative databases, such as the Nationwide Readmissions Database (2019). The objective of the present study was to externally validate the RAI_ICD10 for neurosurgical populations.
Methods: Patients were identified and grouped by major neurosurgical procedure. Binary logistic regression was utilized to model RAI score, elective (vs. nonelective surgery) status, and neurosurgery procedure type by primary endpoint of in-hospital death or transition to comfort care (CMO).
Results: The 460572 cases included spinal fusion (N=256,107), lumbosacral decompression (N=92,351), carotid endartectomy (N=68,064), spinal cord decompression (N=52,593), CNS excision procedure (N=45,296), meninges repair (N=30,893), cervicothoracic decompression (N=22,730), CNS biopsy (N=8792), CNS neurostimulator procedure (N=7688), pituitary tumor resection (N=5939), and decompressive hemicraniectomy (N=5703). Increasing RAI score was associated with stepwise increase in mortality rate: RAI 0-20: 1.0%, 21-30: 6.7%, 31-35: 7.9%, 36-40: 14.1%, 41-45: 19.0%, 46-50: 26.9%, 51+: 28.3%. The RAI (+ procedure type) multivariable model predicted the primary endpoint with c-statistic of 0.900 (95% CI: 0.899-0.901, P< 0.0001). The discriminatory accuracy of RAI score was further analyzed within each procedural cluster, resulting in C-statistics universally within the acceptable to excellent range of predictive ability.
Conclusion : The RAI_ICD10 frailty score was externally validated for neurosurgical patients in a large nationwide administrative database. The frailty score predicts postoperative mortality with outstanding discriminatory accuracy is readily translatable for risk assessment with a user-friendly web application: https://nsgyfrailtyoutcomeslab.shinyapps.io/RAIbyProcedure/ .
