ArticleAnnals of surgery2020
Recalibration and External Validation of the Risk Analysis Index: A Surgical Frailty Assessment Tool.
Article in Annals of surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 103 papers, 2 of them syntheses that pooled it.
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Who cites it
103 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Orthopedic frailty risk stratification (OFRS): a systematic review of the frailty indices predicting adverse outcomes in orthopedics.Journal of orthopaedic surgery and research · 2025Pooled it
- Frailty Screening Using the Risk Analysis Index: A User Guide.Joint Commission journal on quality and patient safety · 2025Pooled it
- Preoperative Rehabilitation Is Feasible in the Weeks Prior to Surgery and Significantly Improves Functional Performance.The Journal of frailty & aging · 2023Trial
- Care Coordination and Optimization in Geriatric Surgery (COGS): A Pilot Program to Improve Surgical Outcomes in Older Adults.Journal of the American Geriatrics Society · 2026Article
- Is There an Ideal Method of Predicting Postoperative Complications Following Major Head and Neck Procedures?: A Comparative Analysis of Three Frailty Indices.Head & neck · 2026Article
- Superior predictive performance of the Risk Analysis Index over the modified Frailty Index-5 in patients undergoing elective anterior cervical procedures among octogenarians.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Understanding the impact of socioeconomic deprivation on inpatient surgical care delivery costs in the Veterans Health Administration.Social sciences & humanities open · 2026Article
- The application value of frailty assessment tools in the perioperative period: A narrative review.Journal of anesthesia and translational medicine · 2026Review
- Compliance with the Veterans Health Administration's Pharmacy Benefit Management guidance for duration of clopidogrel following peripheral vascular interventions: a retrospective cohort study.Journal of managed care & specialty pharmacy · 2026Article
- Risk Analysis Index as a Predictor of Mortality and Failure to Rescue in Patients Undergoing Distal Femur Fracture Fixation.Indian journal of orthopaedics · 2026Article
- Predictive value of the risk analysis index for 30-day mortality following surgical management of thoracolumbar vertebral body fractures.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- The importance of comprehensive geriatric assessment in predicting the outcome of patients with proximal humerus fractures.Aging clinical and experimental research · 2026Article
- Screening for frailty and malnutrition in a multidisciplinary head and neck cancer program.Journal of geriatric oncology · 2026Article
- Risk Analysis Index Outperforms the Modified Frailty Index in Predicting Outcomes in Thyroidectomy and Parathyroidectomy.Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2026Article
- Reconstruction of a Risk Analysis Tool That Uses Nursing Data for Frailty Assessment Among Older Adults: Derivation and Internal Evaluation Study.JMIR aging · 2025Observational
- A systematic review on frailty indices utilized in oncologic surgery and radiotherapy for metastatic spine disease: A critical appraisal of components and performance.North American Spine Society journal · 2025Review
- Prediction of Cardiopulmonary Resuscitation Outcomes for Arrest in Surgical Settings.JAMA network open · 2025Article
- Modified 5-Item Frailty Index and Postoperative Outcomes Following Parotidectomy for Malignancy.Laryngoscope investigative otolaryngology · 2025Article
- Article
- Assessing combined effects of risk analysis index-revised (RAI-rev), malnutrition, and anemia on morbidity and mortality after spine surgery for metastatic spinal tumors.Journal of neuro-oncology · 2025Article
43 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
OBJECTIVE AND
backgroundThe Risk Analysis Index (RAI) predicts 30-, 180-, and 365-day mortality based on variables constitutive of frailty. Initially validated, in a single-center Veteran hospital, we sought to improve model performance by recalibrating the RAI in a large, veteran surgical registry, and to externally validate it in both a national surgical registry and a cohort of surgical patients for whom RAI was measured prospectively before surgery.
methodsThe RAI was recalibrated among development and confirmation samples within the Veterans Affairs Surgical Quality Improvement Program (VASQIP; 2010-2014; N = 480,731) including major, elective noncardiac surgery patients to create the revised RAI (RAI-rev), comparing discrimination and calibration. The model was tested externally in the American College of Surgeons National Surgical Quality Improvement Program dataset (NSQIP; 2005-2014; N = 1,391,785), and in a prospectively collected cohort from the Nebraska Western Iowa Health Care System VA (NWIHCS; N = 6,856).
resultsRecalibrating the RAI significantly improved discrimination for 30-day [c = 0.84-0.86], 180-day [c = 0.81-0.84], and 365-day mortality [c = 0.78-0.82] (P < 0.001 for all) in VASQIP. The RAI-rev also had markedly better calibration (median absolute difference between observed and predicted 180-day mortality: decreased from 8.45% to 1.23%). RAI-rev was highly predictive of 30-day mortality (c = 0.87) in external validation with excellent calibration (median absolute difference between observed and predicted 30-day mortality: 0.6%). The discrimination was highly robust in men (c = 0.85) and women (c = 0.89). Discrimination also improved in the prospectively measured cohort from NWIHCS for 180-day mortality [c = 0.77 to 0.80] (P < 0.001).
conclusionsThe RAI-rev has improved discrimination and calibration as a frailty-screening tool in surgical patients. It has robust external validity in men and women across a wide range of surgical settings and available for immediate implementation for risk assessment and counseling in preoperative patients.
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