A cautionary tale: frailty predicts mortality after deep brain stimulation and the risk analysis index has an unparalleled classification threshold

The Fine Line Between Simplicity and Oversimplification: Comparing the Risk Analysis Index and 5-Factor Modified Frailty Index as Frailty Assessment Tools

“…RAI is an alternative screening tool that evaluates a patient’s overall health status based on various factors, including age, functional dependence, and comorbidities.5,7 RAI offers several advantages, such as its ease of use and integration into clinical workflows [ 7 - 10 ]. Studies in the neurosurgery literature, encompassing a wide range of routinely performed procedures, such as spinal [ 7 ], cranial [ 10 ], and functional [ 8 , 9 ] surgeries, demonstrate that the RAI consistently exhibits superior discrimination compared to mFI-5, and greater patient age [ 7 - 10 ]. Moreover, in these studies the RAI has been shown to be more effective in predicting a wide variety of adverse outcomes [ 7 - 10 ].…”

The risk analysis index demonstrates exceptional discrimination in predicting frailty's impact on neurosurgical length of stay quality metrics

“…For instance, a study involving 20,710 octogenarian neurosurgery patients affirmed RAI's superior prediction ability, particularly concerning 30‐day mortality, eLOS, and pLOS 22 . This trend resonates in other contexts too ‐ from spinal surgeries in underweight patients, where RAI's predictive ability was evident, 33 to deep brain stimulation patients where risk assessment using the RAI also showed superior discrimination 26,34 . These consistent results across multiple studies reinforce the RAI's superior discrimination, and its potential adoption in various surgical subspecialties 23,35 …”

“…22 This trend resonates in other contexts toofrom spinal surgeries in underweight patients, where RAI's predictive ability was evident, 33 to deep brain stimulation patients where risk assessment using the RAI also showed superior discrimination. 26,34 These consistent results across multiple studies reinforce the RAI's superior discrimination, and its potential adoption in various surgical subspecialties. 23,35 Previous studies have consistently emphasized the impact that major complications can have, potentially leading to increased LOS and lowering the overall quality of care received.…”

“…The RAI is a concise, 14-item questionnaire that assesses frailty in five key domains that is based on a range of possible scores from 0 to 81, with 0 being the lowest risk, and 81 being the highest risk. 20,23 There are four overall groups of risk levels, from "robust" (a score of 0-20) to "normal" (a score of [21][22][23][24][25][26][27][28][29][30] to "frail" (a score of [31][32][33][34][35][36][37][38][39][40] to "very frail" (Table 1). The mFI-5 is useful for determining health and functional aspects of frailty based on 5 key variables.…”

Frailty Predicts 30-day mortality following major complications in neurosurgery patients: The risk analysis index has superior discrimination compared to modified frailty index-5 and increasing patient age

“… 8 , 9 , 10 , 11 Frailty is a state of physiological decline, manifesting as a depletion of functional reserve. 11 , 12 , 13 , 14 It is commonly seen in individuals with multiple comorbidities and is associated with worse outcomes across multiple surgical specialties. 8 , 9 , 10 , 13 , 15 Frail patients have increased rates of mortality, postoperative complications, and are more likely to be discharged to facilities with capacity for providing higher-level of care.…”