ArticleNeurosurgical review2026
Assessing effects of RAI, GNRI, and anemia on morbidity and mortality in elderly neurosurgery patients with major complications.
Article in Neurosurgical review, 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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Abstract
Elderly patients with post-operative complications following neurosurgical procedures represent a high-risk population. The combined effects of frailty, poor nutritional status, and anemia on morbidity and mortality in such patients remains poorly defined. This study aimed to assess the interplay of revised Risk Analysis Index (RAI-rev), Geriatric Nutritional Risk Index (GNRI), and anemia in this prognostication of this population. A retrospective cohort study was performed using the 2011-2023 National Surgical Quality Improvement Program (NSQIP) database. Patients aged 65 and older with Clavien-Dindo (CD) grade complications ≥ 3 following neurosurgical procedures were identified using Current Procedural Terminology (CPT) and International Classification Of Disease (ICD) codes. The study population was divided based on RAI-rev frailty status, with frail patients further subdivided based on anemia and GNRI status. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent predictors of extended hospital length of stay (LOS), non-routine discharge (NRD), and 30-day mortality. Of the 9,862 patients, 2,468 (25.0%) were frail alone (F), 1,534 (15.6%) frail and anemic (FA), 1,430 (14.5%) frail and malnourished (FM), 2,976 (30.2%) frail, anemic, and malnourished (FAM), and 1,454 (14.7%) not frail (NF). On multivariable analysis, extended LOS was independently associated with a lower GNRI score (p < 0.001), higher RAI-rev (p < 0.001), and anemia (p < 0.001). NRD was independently associated with a lower GNRI score (p < 0.001) and anemia (p = 0.027). 30-day mortality was independently associated with a lower GNRI score (p < 0.001) and higher RAI-rev (p < 0.001). Relative to RAI-rev alone, the RAI-rev + anemic (p < 0.001), RAI-rev + GNRI (p < 0.001), and RAI-rev + anemic + GNRI (p < 0.001) models were superior predictors for extended LOS. For NRD, the RAI-rev + GNRI (p = 0.025) and RAI-rev + anemic + GNRI (p = 0.029) models were superior. For 30-day mortality, the RAI-rev + GNRI (p < 0.001) and RAI-rev + anemic + GNRI (p < 0.001) models were superior. Our findings demonstrate the superior predictive capacity of RAI-rev, anemia, and GNRI for LOS, NRD, and 30-day mortality in elderly neurosurgery patients with CD grade III/IV complications. A comprehensive preoperative assessment including RAI-rev, anemia, and GNRI may provide superior prognostic stratification compared to RAI-rev alone.
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