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Otologic Surgery Risk Prediction: Risk Analysis Index-Administrative Versus Modified Frailty Index-5.

Akshay Warrier1,2, Nicole Kim2,3, Ryan Bartholomew2,3

  • 1Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

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Summary
This summary is machine-generated.

The Risk Analysis Index-Administrative (RAI-A) is a better predictor of surgical outcomes than the modified frailty index (mFI-5) in otologic and skull base surgeries. RAI-A improves risk stratification for patients undergoing these complex procedures.

Keywords:
frailtymodified frailty indexotologic surgerypostoperative outcomesrisk analysis index

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Geriatric Medicine

Background:

  • Frailty indices like mFI-5 and RAI-A are used for surgical risk stratification.
  • Their comparative effectiveness in otology/neurotology is not well-established.

Purpose of the Study:

  • To compare the predictive performance of RAI-A and mFI-5 for postoperative outcomes in otologic and lateral skull base surgery.
  • To evaluate the utility of RAI-A in risk stratification for complex neurotologic procedures.

Main Methods:

  • Retrospective analysis of 2862 otologic surgery patients.
  • Assessment of frailty using RAI-A and mFI-5.
  • Evaluation of predictive performance for 30-day mortality, complications (Clavien-Dindo), surgical site infection, nonhome discharge, and extended length of stay using logistic regression and ROC curves.

Main Results:

  • RAI-A showed superior discrimination for mortality, Clavien-Dindo II complications, and surgical site infection compared to mFI-5.
  • RAI-A was significantly associated with severe complications (CD IIIb), extended length of stay, and mortality in skull base surgery.
  • RAI-A predicted higher odds of mortality, serious complications (CD IV), and nonhome discharge in the skull base subset.

Conclusions:

  • RAI-A outperforms mFI-5 in predicting postoperative outcomes in otologic surgery.
  • RAI-A demonstrates similar predictive superiority in high-risk lateral skull base cases.
  • RAI-based frailty assessment should be incorporated into preoperative planning for improved risk stratification and patient counseling.