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

Frailty indices, including the modified frailty index (mFI-5) and the risk analysis index-administrative (RAI-A), are increasingly used to stratify surgical risk; however, their comparative utility in otology/neurotology remains understudied. This study compares the predictive performance of RAI-A versus mFI-5 for postoperative outcomes in a large otologic and lateral skull base cohort.

A retrospective analysis of 2862 otologic surgery patients was performed. Primary outcomes included 30-day mortality, Clavien-Dindo (CD) complications, surgical site infection (SSI), nonhome discharge, and extended length of stay (eLOS). Frailty was assessed using validated indices, and predictive performance was evaluated using multivariate logistic regression and ROC curves.

Across the full cohort, RAI-A demonstrated superior discrimination (C-statistic) compared to mFI-5 for mortality (0.809 vs. 0.722, p = 0.021), CD II complications (0.793 vs. 0.788, p = 0.048), and SSI (0.721 vs. 0.712, p = 0.047). On multivariable analysis, RAI-A was significantly associated with CD II (OR 7.545; CI 2.367-24.048), CD IIIb (OR 17.925; CI 1.641-195.753), and eLOS (OR 40.623; CI 4.966-336.395). In the skull base subset, RAI-A was associated with higher odds of mortality (OR 14.47, 95% CI 3.02-69.31), serious complications (CD IV; OR 3.56, 95% CI 1.36-9.31), and nonhome discharge (OR 18.20, 95% CI 6.35-52.17).

RAI-A outperforms mFI-5 in predicting postoperative outcomes in otologic surgery, with similar findings for high-risk lateral skull base cases. These findings support incorporating RAI-based frailty assessment into preoperative planning to improve risk stratification and patient counseling.