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

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.