Abstract Details

Title Superior Predictive Performance of the Risk Analysis Index Over the Modified Frailty Index-5 in Patients Undergoing Anterior Cervical Discectomy and Fusion Among Octogenarians

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 13-009

Objective To compare the predictive performance of the modified Frailty Index-5 (mFI-5) and the Risk Analysis Index (RAI) in octogenarians undergoing elective anterior cervical procedures.

Background Anterior cervical spine procedures in octogenarians carry high perioperative risk. Frailty is a known predictor of surgical outcomes, yet the comparative performance of different frailty indices in this population is unclear.

Design/Methods We analyzed ACS-NSQIP data (2015–2021) for patients aged 80–89 years undergoing anterior cervical procedures. The primary outcome was 30-day mortality; secondary outcomes included major complications, readmission, reoperation, and non-home discharge. Frailty was assessed with mFI-5 and RAI. Multivariable logistic regression and AUROC analysis with DeLong test and bootstrap validation evaluated model performance.

Results Among 870 patients, 19.5% were frail by RAI and 14.5% by mFI-5. RAI demonstrated superior discrimination for 30-day mortality (AUROC 0.830 vs 0.514, p<0.001; adjusted OR 1.31, 95% CI 1.14–1.50). RAI also outperformed mFI-5 for non-home discharge (AUROC 0.674 vs 0.528, p<0.001), readmission (0.607 vs 0.504, p=0.022), and extended length of stay (0.627 vs 0.540, p=0.003). Bootstrap validation confirmed stability of results.

Conclusions RAI demonstrated superior discrimination compared to mFI-5 for predicting mortality and postoperative outcomes in octogenarians undergoing anterior cervical procedures. RAI may provide more accurate risk stratification, supporting improved surgical planning, perioperative management, and patient counseling in this high-risk population.

Authors/Disclosures
Mustafa Abdul Kareem, MD PRESENTER	Dr. Abdul Kareem has nothing to disclose.
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.