Risk Analysis Index Versus Modified Frailty Index: Outcomes After Otolaryngologic Surgery

Patient frailty negatively impacts postsurgical outcomes across multiple specialties. Commonly used frailty scoring systems include the Modified 5-Item Frailty Index (MFI-5) and the Clinical Risk Analysis Index (RAI-C). We compared these frailty indices in predicting postsurgical outcomes in otolaryngology, a comparison that has never been completed to date.

Retrospective chart review of patients undergoing otolaryngologic surgery at a quaternary care medical center (2022-2024) with an RAI-C score available for analysis. Chi-square analysis and ROC curves were utilized to determine associations and predictive ability of each scoring system.

Among 1209 patients, 21% met MFI-5 frailty criteria (MFI-5 score > 1), and 23% met RAI-C frailty criteria (RAI-C score > 30). The Pearson correlation coefficient between MFI-5 and RAI-C was 0.481 (95% CI [0.43, 0.53]), indicating a moderate correlation between the two metrics. Patients deemed frail by RAI-C had 5.7 times higher odds of experiencing a postoperative complication than non-frail counterparts (95% CI [3.51, 9.28], p < 0.0001), but MFI-5 frailty status was not associated with postoperative complications. Both RAI-C and MFI-5 demonstrated significant predictive ability for 30-day readmission (AUC 0.77, 95% CI [0.64, 0.89] vs. AUC 0.76, 95% CI [0.61, 0.88]), respectively. When compared to MFI-5, RAI-C had greater predictive performance for all other postoperative outcomes in this study.

RAI-C outperformed MFI-5 in predicting postoperative outcomes in patients undergoing otolaryngologic surgeries. RAI-C assessment should be considered in frailty research, multidisciplinary treatment planning, and managing patient expectations and outcomes.