Abstract Details

Title Risk Analysis Index Outperforms Modified Frailty Index-Five for Predicting Adverse Outcomes Following Anterior Lumbar Interbody Fusion in a National Cohort of 2,806 Patients With Active Smoking Status

Topic Neuro-rehabilitation

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 14-003

Objective To compare the predictive performance of the modified Frailty Index-5 (mFI-5) and the Risk Analysis Index (RAI) for postoperative outcomes in active smokers undergoing ALIF.

Background Anterior lumbar interbody fusion (ALIF) accounts for a substantial proportion of spinal fusions in the United States. Frailty assessment may improve risk stratification, particularly in vulnerable populations such as active smokers, but comparative performance of different indices is uncertain.

Design/Methods We analyzed ACS-NSQIP data (2015–2021) for patients aged ≥50 years who underwent elective ALIF and were active smokers. Frailty was assessed with mFI-5 and RAI. Multivariable logistic regression evaluated associations with outcomes. Model discrimination was assessed with AUROC and compared using the DeLong test, with bootstrap validation.

Results Among 2,806 patients, 50.3% were frail by mFI-5 and 22.9% by RAI. Non-home discharge occurred in 10.2%. The RAI demonstrated superior discrimination compared to mFI-5 for non-home discharge (AUROC 0.732 vs 0.639, p<0.001), extended length of stay (0.633 vs 0.568, p<0.001), and minor complications (0.698 vs 0.520, p=0.013). Predictive performance was similar for mortality, readmission, and reoperation.

Conclusions RAI outperformed mFI-5 in predicting non-home discharge and select complications following ALIF in active smokers. These findings support the RAI as a more effective tool for preoperative frailty assessment and perioperative planning in this high-risk population.

Authors/Disclosures
Bashar Quteishat, MD PRESENTER	No disclosure on file
Cameron J. Sabet, MD	Mr. Sabet has nothing to disclose.
Bhav Jain, BS	Mr. Jain has received personal compensation for serving as an employee of National Academy of Medicine.
Bara M. Hammadeh	Mr. Hammadeh has nothing to disclose.
Stefan Prulovic, MD	Mr. Prulovic has nothing to disclose.
Weaam Masoud, MD	Dr. Masoud has nothing to disclose.