Evidence map›Paper›PMID 42115419›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

Superior predictive performance of the Risk Analysis Index over the modified Frailty Index-5 in patients undergoing elective anterior cervical procedures among octogenarians.

Cameron J Sabet, Bhav Jain, Bara M Hammadeh, Perisa Ashar, Jad Lawand, Stefan Prulovic, Dang Nguyen, Weaam A Masoud

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Article in 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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

8 authors.

Cameron J SabetGeorgetown University Medical Center, Washington D.C., USA.
Bhav JainStanford Medicine, Stanford, USA.
Bara M HammadehAl-Balqa Applied University, Salt, Jordan. barahammadeh2005@gmail.com.
Perisa AsharDuke University, Durham, USA.
Jad LawandThe University of Texas Medical Branch at Galveston, Galveston, USA.
Stefan PrulovicGeorgetown University Medical Center, Washington D.C., USA.
Dang NguyenBrigham and Women's Hospital, Boston, USA.
Weaam A MasoudDepartment of Spine and Orthopedic Surgery, King Hussein Cancer Center, Amman, Jordan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnterior cervical procedures in octogenarians carry substantial perioperative risks, underscoring the need for accurate preoperative assessment. Frailty, defined as diminished physiological reserve, is a recognized predictor of adverse surgical outcomes. Two validated measures-the modified 5-Factor Frailty Index (mFI-5) and the Risk Analysis Index (RAI)-are widely used, but their comparative predictive performance in this population is not well established. We aim to compare the predictive performance of mFI-5 versus RAI for 30-day postoperative outcomes following elective anterior cervical procedures in octogenarians.

methodsWe conducted a retrospective cohort study using ACS-NSQIP data (2015-2021) of patients aged 80-89 years undergoing elective anterior cervical procedures. The primary outcome was 30-day mortality, with secondary outcomes of major complications, readmission, reoperation, and non-home discharge. Frailty was measured by mFI-5 and RAI, univariate AUROC comparisons were performed for each frailty index separately, followed by multivariable adjustment. Internal validation was performed using bootstrap resampling, with enhanced sensitivity analyses for mortality.

resultsAmong 870 patients, RAI classified 19.5% as frail versus 14.5% by mFI-5. In univariate analysis, RAI demonstrated superior discrimination for 30-day mortality (AUROC 0.830 vs. 0.514, p < 0.001) with an unadjusted OR of 1.31 (95%CI:1.14-1.50). However, given the low number of mortality events (n = 7), these findings should be interpreted with caution. RAI also showed better discrimination for non-home discharge (0.674 vs. 0.528, p < 0.001), readmission (0.607 vs. 0.504, p = 0.022), and extended length-of-stay (0.627 vs. 0.540, p = 0.003). After multivariable adjustment, RAI maintained superior predictive performance across outcomes. Bootstrap-validated AUROCs confirmed RAI superiority.

conclusionsRAI demonstrated superior discrimination compared to mFI-5 for predicting mortality and postoperative outcomes in octogenarians undergoing anterior cervical surgery. While RAI showed promising discrimination for mortality, these results require validation in larger cohorts due to the low event rate. Therefore, the RAI should be preferred over the mFI-5 for preoperative risk stratification in octogenarians undergoing anterior cervical surgery.

Indexed as

Cervical VertebraeElective Surgical ProceduresFrailtyPostoperative ComplicationsAged, 80 and overFemaleHumansMaleOctogenariansPredictive Value of TestsRetrospective StudiesRisk AssessmentElective anterior cervical proceduresFunctional recoveryNeurological spine surgeryOrthopedicsSurgical complications

Identifiers

PMID42115419

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.