The Validity of Frailty Scoring in Preoperative Risk Assessment for Patients in the Surgical Intensive Care Unit

The National Surgical Office through the Department of Veterans Affairs recommends using the Risk Analysis Index (RAI) to gauge preoperative frailty and identify patients at heightened risk of adverse postoperative events. We aimed to evaluate the validity of RAI scores in predicting early intensive care unit (ICU) mortality and complications in surgical patients.

We retroactively computed RAI scores for surgical patients admitted to the ICU between January 2019 and December 2022. The primary endpoint was 30-d mortality, with secondary endpoints including overall mortality and ICU stay duration. Receiver-operating characteristic analysis determined the RAI cutoff, dividing patients into "Frail" or "Robust" groups. We assessed adverse event frequency and survival using chi-square and Kaplan-Meier tests.

Among 541 surgical patients admitted to the ICU, RAI scores emerged as a robust predictor (area under the curve 0.815 ± 0.027) of 30-d mortality, with a sensitivity of 87.9% and specificity of 56.6% at a cutoff value of 33.5, as well as 1-y mortality. The Frail group exhibited an eight-fold increase in 30-d and an approximate seven-fold increase in 4-y mortality rates compared to the Robust group (P < 0.001). ICU and hospital lengths of stay were significantly more prolonged in Frail patients.

This study underscores the efficacy of RAI scoring in predicting postoperative survival and postoperative length of stay. Patients with high RAI scores may benefit from additional preoperative optimization of modifiable risk factors, especially in nonemergent cases.