Preoperative frailty risk in deep brain stimulation patients: Risk analysis index predicts Clavien-Dindo IV complications

Owodunni, Oluwafemi P.; Roster, Katie; Varela, Samantha; Kazim, Syed Faraz; Okakpu, Uchenna; Tarawneh, Omar; Thommen, Rachel; Kogan, Michael; Sheehan, Jason P.; McKee, Rohini; Deligtisch, Amanda; Schmidt, Meic H.; Bowers, Christian A.

doi:10.1016/j.clineuro.2023.107616

Cited by 16 publications

(18 citation statements)

References 36 publications

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“…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 …”

Section: Discussionmentioning

confidence: 53%

“…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.…”

Section: Variablesmentioning

confidence: 56%

“…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.…”

Section: Frailty Screen Toolsmentioning

confidence: 99%

“…23,24 A variety of factors, including demographic, clinical variables, and impairment in activities of daily living, are incorporated into these risk assessment tools. 20,[22][23][24][25][26] Frail patients are frequently encountered during surgical evaluation, therefore, a quick and reliable method to measure frailty in surgical candidates is essential. [27][28][29] This is the first study, to our knowledge, that broadly examines the impact of frailty on the relevant LOS quality metrics that is, extended LOS (eLOS), prolonged length of stay within 30 days (pLOS), and length of hospital stay >30 days (LOS >30).…”

Section: Introductionmentioning

confidence: 99%

“…The Risk Analysis Index (RAI) and the Modified 5‐Item Frailty Index (mFI‐5) are two examples of risk assessment tools developed and validated to assess frailty across populations 23,24 . A variety of factors, including demographic, clinical variables, and impairment in activities of daily living, are incorporated into these risk assessment tools 20,22–26 . Frail patients are frequently encountered during surgical evaluation, therefore, a quick and reliable method to measure frailty in surgical candidates is essential 27–29 …”

Section: Introductionmentioning

confidence: 99%

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

Gagliardi,

Conti,

Courville

et al. 2023

World j. surg.

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BackgroundQuality measures determine reimbursement rates and penalties in value‐based payment models. Frailty impacts these quality metrics across surgical specialties. We compared the discriminatory thresholds for the risk analysis index (RAI), modified frailty index‐5 (mFI‐5) and increasing patient age for the outcomes of extended length of stay (LOS [eLOS]), prolonged LOS within 30 days (pLOS), and protracted LOS (LOS > 30).MethodsPatients ≥18 years old who underwent neurosurgical procedures between 2012 and 2020 were queried from the ACS‐NSQIP. We performed receiver operating characteristic analysis, and multivariable analyses to examine discriminatory thresholds and identify independent associations.ResultsThere were 411,605 patients included, with a median age of 59 years (IQR, 48–69), 52.2% male patients, and a white majority 75.2%. For eLOS: RAI C‐statistic 0.653 (95% CI: 0.652–0.655), versus mFI‐5 C‐statistic 0.552 (95% CI: 0.550–0.554) and increasing patient age C‐statistic 0.573 (95% CI: 0.571–0.575). Similar trends were observed for pLOS‐ RAI: 0.718, mFI‐5: 0.568, increasing patient age: 0.559, and for LOS>30‐ RAI: 0.714, mFI‐5: 0.548, and increasing patient age: 0.506. Patients with major complications had eLOS 10.1%, pLOS 26.5%, and LOS >30 45.5%. RAI showed a larger effect for all three outcomes, and major complications in multivariable analyses.ConclusionIncreasing frailty was associated with three key quality metrics that is, eLOS, pLOS, LOS > 30 after neurosurgical procedures. The RAI demonstrated a higher discriminating threshold compared to both mFI‐5 and increasing patient age. Preoperative frailty screening may improve quality metrics through risk mitigation strategies and better preoperative communication with patients and their families.

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Section: Discussionmentioning

confidence: 53%