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Utility of Revised Risk Analysis Index as a Predictor of Mortality and Morbidity in Orthopaedic Trauma
Chirag Soni1, Victor Koltenyuk, Nithin Gupta
1From the Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN (Dr. Soni, Dr. Lopas, and Dr. Szatkowski); the Research, Education, and Mentorship in Orthopedics (REAM) Organization, Colombus, OH (Dr. Soni, Mr. Koltenyuk, Dr. Gupta, Dr. Arif, Mr. Areti, Dr. Manes, Dr. Lopas, Dr. Szatkowski, Dr. Bowers, Dr. Taylor, and Dr. Weick); the Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT (Dr. Soni, Dr. Gupta, and Dr. Bowers); the School of Medicine, New York Medical College, Valhalla, NY (Mr. Koltenyuk); the School of Osteopathic Medicine, Campbell University, Lillington, NC (Dr. Gupta); the School of Medicine, University of California Riverside, Riverside, CA (Dr. Arif); the School of Medicine, Baylor College of Medicine, Houston, TX (Mr. Areti); the Department of Orthopaedic Surgery, OhioHealth System, Columbus, OH (Dr. Manes, Dr. Taylor, and Dr. Weick); and the Hurley Neurological Center, Hurley Medical Center, Flint, MI (Dr. Bowers).
Objectives:
The aim of this study was to determine the applicability of the Revised Risk Analysis Index (RAI-Rev) in orthopaedic trauma and compare the predictive discrimination for the RAI-Rev and the 5-Item Modified Frailty Index (mFI-5) for 30-day postoperative outcomes.
Design:
This is a retrospective cohort study.
Setting:
The American College of Surgeons National Surgical Quality Improvement database was used.
Patient Selection:
All patients aged 18 or older who underwent surgical treatment for forearm, humerus, pelvis, acetabulum, femur, tibia, and hindfoot fractures from 2015 to 2020 were included.
Outcome:
30-day postoperative mortality, major complications, and wound complications consisting of surgical site infection, and wound dehiscence were measured.
Results:
A total of 206,352 patients met inclusion criteria. The mean age was 69 years, with 64.2% (n = 132,514) being female. Multivariate regression analysis showed that increasing frailty tiers in both RAI-Rev and mFI-5 were independent predictors of mortality, major complications, readmission, and wound complications. The cohort with the highest degree of frailty in both RAI-Rev and mFI-5 had the greatest risk of poor outcomes. RAI-Rev had significantly superior predictive discriminatory thresholds compared with mFI-5 for predicting 30-day mortality (C-statistic: RAI-Rev [0.84] and mFI-5 [0.67], P < 0.001), major complications (C-statistic: RAI-Rev [0.73] and mFI-5 [0.65], P < 0.001), and readmission (C-statistic: RAI-Rev [0.68] and mFI-5 [0.63], P < 0.001). However, mFI-5 outperformed RAI-Rev when predicting wound complications (C-statistic: RAI-Rev [0.52] and mFI-5 [0.55], P < 0.001).
Conclusion:
The RAI-Rev tool demonstrated superior predictability of postoperative morbidity, mortality, and readmission rates compared with mFI-5 but was less effective in predicting surgical site complications. These findings demonstrate the utility of RAI-Rev in anticipating postoperative complications in the setting of orthopaedic trauma, where optimizing surgical candidate selection is not always possible. Assessing the predicted morbidity and mortality through RAI-Rev enables surgeons to accurately identify patients at high risk of complications, which can further research investigation to mitigate this risk.
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