Development and Initial Validation of the Risk Analysis Index for Measuring Frailty in Surgical Populations.

Area of Science:

• Gerontology and Geriatric Medicine
• Surgical Outcomes Research
• Health Services Research

Background:

• Growing evidence supports incorporating frailty risks into surgical decision-making.
• Current methods for screening surgical patients for frailty are not well-defined.
• Accurate frailty assessment is crucial for predicting postoperative complications.

Purpose of the Study:

• To develop and validate the 14-item Risk Analysis Index (RAI) for measuring surgical frailty.
• To assess the prospective (RAI-C) and retrospective (RAI-A) calculation methods of the RAI.
• To evaluate the predictive performance of the RAI compared to other frailty indices.

Main Methods:

• A prospective cohort study was conducted at a Veterans Affairs Medical Center involving patients undergoing elective surgery.
• The RAI-C was administered preoperatively, and RAI-A was calculated retrospectively using quality improvement data.
• Receiver operating characteristic (ROC) analysis and C-statistics were used to assess predictive accuracy for mortality and morbidity.

Main Results:

• The RAI-C demonstrated a C-statistic of 0.772 for predicting 180-day mortality.
• RAI-A and RAI-C showed strong predictive performance (C-statistics 0.823 and 0.824) when linked to quality improvement data.
• The RAI-C identified 18.3% of patients as frail with good sensitivity (0.50) and specificity (0.82).

Conclusions:

• The RAI-C and RAI-A are effective instruments for assessing surgical frailty, with predictive capabilities comparable to existing tools.
• The RAI-C is a feasible tool for large-scale preoperative frailty screening in clinical practice.
• Further research is needed to optimize the components of preoperative frailty assessment.