Risk Analysis Index as a Predictor of Mortality and Failure to Rescue in Patients Undergoing Distal Femur Fracture...

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Surgical Outcomes Research

Background:

• Distal femur fractures (DFFs) are common in elderly patients, often requiring surgical fixation.
• Predicting adverse outcomes like mortality and failure to rescue (FTR) is crucial for optimizing perioperative care.
• Current predictors like age and American Society of Anesthesiologists (ASA) score may not fully capture patient risk.

Purpose of the Study:

• To compare the predictive accuracy of frailty indices against age and ASA score for mortality and FTR in DFF patients.
• To evaluate the utility of the 5-Item Modified Frailty Index (mFI-5) and Risk Analysis Index (RAI) in this surgical population.
• To determine if frailty assessment can serve as a bedside tool for identifying high-risk patients.

Main Methods:

• Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for DFF surgical fixation.
• Inclusion of 2638 patients with assessment of frailty using mFI-5 and RAI.
• Multivariate regression and receiver operating characteristic (ROC) curve analyses to assess predictive performance (odds ratio and C-statistic).

Main Results:

• Increasing frailty (mFI-5 and RAI) correlated significantly with higher odds of 30-day mortality and FTR.
• The RAI demonstrated superior discriminatory accuracy for predicting 30-day mortality and FTR compared to mFI-5, age, and ASA score.
• 3.4% of patients experienced mortality and 1.9% experienced FTR.

Conclusions:

• The Risk Analysis Index (RAI) shows superior predictive value and discriminatory accuracy for postoperative mortality in DFF patients.
• Frailty, particularly as measured by RAI, can be a valuable bedside screening tool to identify at-risk individuals.
• Preoperative optimization of identified high-risk patients can potentially improve clinical outcomes and reduce adverse events.