Objective To evaluate the prognostic utility of baseline frailty, measured by the Risk Analysis Index (RAI), for prediction of postoperative mortality among patients with spinal malignancy (SM) undergoing resection.
Methods SM surgery cases were queried from the American College of Surgeons – National Surgical Quality Improvement Program database (2011–2020). The relationship between preoperative RAI frailty score and increasing rate of primary endpoint (mortality or discharge to hospice within 30 days, “mortality/hospice”) were assessed. Discriminatory accuracy was assessed by computation of C-statistics (with 95% confidence interval [CI]) in receiver operating characteristic (ROC) curve analysis.
Results A total of 2,235 cases were stratified by RAI score: 0–20, 22.7%; 21–30, 11.9%; 31–40, 54.7%; and ≥ 41, 10.7%. The rate of mortality/hospice was 6.5%, which increased linearly with increasing RAI score (p < 0.001). RAI was also associated with increasing rates of major complication, extended length of stay, and nonhome discharge (all p < 0.05). The RAI demonstrated acceptable discriminatory accuracy for prediction of primary endpoint (C-statistic, 0.717; 95% CI, 0.697–0.735). In pairwise ROC comparison, RAI demonstrated superiority versus modified frailty index-5 and chronological age (p < 0.001).
Conclusion Preoperative frailty, as measured by RAI, is a robust predictor of mortality/ hospice after SM surgery. The frailty score may be applied in clinical settings using a user-friendly calculator, deployed here: https://nsgyfrailtyoutcomeslab.shinyapps.io/spinalMalignancyRAI/.
Citations
Citations to this article as recorded by
Comparison of the Risk Analysis Index and the Modified 5-Item Frailty Index in Predicting 30-Day Morbidity and Mortality After Occipitocervical Fusion Omar Sbaih, Nithin K. Gupta, Dilibe Ekowa, Stefan Prvulovic, Kush Modi, Mark Miller, Rohin Singh, William DiCiurcio, Ruchir Nanavati, Matthew H. Meade, Jonathan Stone, Christian Bowers Global Spine Journal.2026; 16(4): 1917. CrossRef
Leveraging automated machine learning to benchmark, deconstruct, and compare frailty indices for predicting adverse spinal surgery outcomes Attri Ghosh, Philip J. Freda, Shane Shahrestani, Alena Orlenko, Justin K. Scheer, Tayo Obafemi-Ajayi, Jason H. Moore, Corey T. Walker Scientific Reports.2026;[Epub] CrossRef
Otologic Surgery Risk Prediction: Risk Analysis Index‐Administrative Versus Modified Frailty Index‐5 Akshay Warrier, Nicole Kim, Ryan Bartholomew, Liliya Benchetrit, Daniel J. Lee The Laryngoscope.2026;[Epub] CrossRef
Comparison of the performance metrics of two frailty scales in spinal surgery: a systematic review and meta-analysis Carmelo VENERO Jr. Jr., Niels PACHECO-BARRIOS, Joanna M. ROY, Stefan T. PRVULOVIC, Gilberto PEREZ RODRIGUEZ GARCIA, Yusor AL-NUAIMY, Andre A. PAYMAN, Akshay WARRIER, Fielding L. HORNE, Aryan GAJJAR, Hikmat R. CHMAIT, Nithin GUPTA, Sanjeev HERR, Pemla JAGT Journal of Neurosurgical Sciences.2026;[Epub] CrossRef
Metastatic spinal tumor frailty index and New England spinal metastasis score show the most consistent performance for short-term postoperative outcomes: Single-center validation in 114 patients Joseph A. Oldam, Mazen Taman, Weston C. de Lomba, Christian Schroeder, Owen P. Leary, Alexander A. Chernysh, Jonathan Arditi, Adetokunbo A. Oyelese, Jared S. Fridley, Tianyi Niu, Joaquin Q. Camara, Albert E. Telfeian, Ziya L. Gokaslan, Patricia L. Zadnik North American Spine Society Journal (NASSJ).2026; 27: 100894. CrossRef
A Commentary on “Impact of Paraspinal Muscle Degeneration on Surgical Outcomes and Radiographical Sagittal Alignment in Adult Spinal Deformity: A Multicenter Study” Yutaro Kanda Neurospine.2025; 22(1): 38. CrossRef
Letter: Surgical Fixation of Thoracolumbar Fractures in Patients Older Than 80 Years Michael M. Covell, Shubhang Bhalla, Christian A. Bowers Neurosurgery.2025; 97(1): e38. CrossRef
Clinical Utility and Actionability of Failure to Rescue Prediction Model for Thoracolumbar Fusion: A Focus on Variable Relevance – A Commentary on “A Predictive Model of Failure to Rescue After Thoracolumbar Fusion” Seyed Amirhossein Tabatabaei, Mohammad Reza Cheraghi Neurospine.2025; 22(2): 615. CrossRef
Risk analysis index-measured frailty as a critical predictor of outcomes in patients with non-normal pressure hydrocephalus undergoing first-time shunt surgery: A nationwide study Gilberto Perez Rodriguez Garcia, S. Farzad Maroufi, Fnu Ruchika, Danisha Kumar, Christian Bowers, Sarah T. Menacho Clinical Neurology and Neurosurgery.2025; 256: 109012. CrossRef
The dynamic nature of frailty in metastatic spine disease patients Oludotun Ogunsola, Edward S. Harake, Sean Smith, Michael Albdewi, Varun Kathawate, Sebele Ogunsola, William Jackson, Joseph Evans, Vikram Chakravarthy, Nicholas Szerlip Journal of Neuro-Oncology.2025; 175(3): 1247. CrossRef
Frailty assessment in acute spinal cord injury surgery: Insights from the risk analysis index and broader neurosurgical context Omar Sbaih, Stefan Prvulovic, Shubhang Bhalla, Michael Covell, Christian A. Bowers The Journal of Spinal Cord Medicine.2025; : 1. CrossRef
From the Editor-in-Chief: Featured Articles in the June 2024 Issue Inbo Han Neurospine.2024; 21(2): 373. CrossRef
Commentary on “Baseline Frailty Measured by the Risk Analysis Index and 30-Day Mortality After Surgery for Spinal Malignancy: Analysis of a Prospective Registry (2011–2020)” Fon-Yih Tsuang Neurospine.2024; 21(2): 414. CrossRef
Objective Although failure to rescue (FTR) has been utilized as a quality-improvement metric in several surgical specialties, its current utilization in spine surgery is limited. Our study aims to identify the patient characteristics that are independent predictors of FTR among thoracolumbar fusion (TLF) patients.
Methods Patients who underwent TLF were identified using relevant diagnostic and procedural codes from the National Surgical Quality Improvement Program (NSQIP) database from 2011–2020. Frailty was assessed using the risk analysis index (RAI). FTR was defined as death, within 30 days, following a major complication. Univariate and multivariable analyses were used to compare baseline characteristics and early postoperative sequelae across FTR and non-FTR cohorts. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory accuracy of the frailty-driven predictive model for FTR.
Results The study cohort (N = 15,749) had a median age of 66 years (interquartile range, 15 years). Increasing frailty, as measured by the RAI, was associated with an increased likelihood of FTR: odds ratio (95% confidence interval [CI]) is RAI 21–25, 1.3 [0.8–2.2]; RAI 26–30, 4.0 [2.4–6.6]; RAI 31–35, 7.0 [3.8–12.7]; RAI 36–40, 10.0 [4.9–20.2]; RAI 41– 45, 21.5 [9.1–50.6]; RAI ≥ 46, 45.8 [14.8–141.5]. The frailty-driven predictive model for FTR demonstrated outstanding discriminatory accuracy (C-statistic = 0.92; CI, 0.89–0.95).
Conclusion Baseline frailty, as stratified by type of postoperative complication, predicts FTR with outstanding discriminatory accuracy in TLF patients. This frailty-driven model may inform patients and clinicians of FTR risk following TLF and help guide postoperative care after a major complication.
Citations
Citations to this article as recorded by
Predictive value of the risk analysis index for 30-day mortality following surgical management of thoracolumbar vertebral body fractures Stefan Prvulovic, Nithin Gupta, Sina Zhogi, Charles Bowers, Kishan Shah, Alfred Marcinkowski, Anjali Gupta, Christian Bowers European Spine Journal.2026; 35(4): 1964. CrossRef
Is the “Fix-and-Replace” Method Associated With Higher Early Perioperative Risk Than Isolated Internal Fixation for Acetabular Fractures in Frail Patients? Tyler K. Williamson, Luke Verlinsky, Loc-Uyen Vo, Ravi Karia, Case Martin Journal of Orthopaedic Trauma.2026; 40(4): 196. CrossRef
Frailty and the Older Neurosurgical Patient: Assessment, Outcomes and Management Adele S. Budiansky, Dan Budiansky, Daniel I. McIsaac Current Anesthesiology Reports.2025;[Epub] CrossRef
Frailty Predicts Failure to Rescue Following Malignant Brain Tumor Resection: A National Surgical Quality Improvement Program Analysis of 14,721 Patients/ (2012–2020) Stefan T. Prvulovic, Joanna M. Roy, Akshay Warrier, Pemla Jagtiani, Joe Hirsch, Michael M. Covell, Christian A. Bowers World Neurosurgery.2025; 195: 123671. CrossRef
Failure to Rescue After Brain Tumor Resection: A National Surgical Quality Improvement Program Analysis (2012-2020) Joanna M. Roy, Stefan T. Prvulovic, Akshay Warrier, Arash K. Mousavi, Shubhang Bhalla, Damian Sanchez, Pemla Jagtiani, Vinay Verma, Jonathan Roy Varghese, Praveen Sanmuganthan, Johnny Delashaw, Christian A. Bowers Neurosurgery.2025; 97(5): 1170. CrossRef
Clinical Utility and Actionability of Failure to Rescue Prediction Model for Thoracolumbar Fusion: A Focus on Variable Relevance – A Commentary on “A Predictive Model of Failure to Rescue After Thoracolumbar Fusion” Seyed Amirhossein Tabatabaei, Mohammad Reza Cheraghi Neurospine.2025; 22(2): 615. CrossRef
Reply Letter: A Commentary on “A Predictive Model of Failure to Rescue After Thoracolumbar Fusion” Joanna M. Roy, Aaron C. Segura, Michael M. Covell, Christian A. Bowers Neurospine.2025; 22(2): 617. CrossRef
Frailty assessment in acute spinal cord injury surgery: Insights from the risk analysis index and broader neurosurgical context Omar Sbaih, Stefan Prvulovic, Shubhang Bhalla, Michael Covell, Christian A. Bowers The Journal of Spinal Cord Medicine.2025; : 1. CrossRef
Serum Albumin Level as a Predictor of Failure to Rescue in Patients Undergoing Surgery for Spinal Metastases Esli Nájera Samaniego, Rose Fluss, Ali Haider Bangash, Sertac Kirnaz, Saikiran Murthy, Yaroslav Gelfand, Reza Yassari, Rafael De La Garza Ramos Cancers.2025; 17(21): 3477. CrossRef
Discriminatory Value of the Risk Analysis Index Versus the 5-Factor Modified Frailty Index for Major Outcome Measures in Degenerative Cervical Myelopathy Nithin K. Gupta, Sina Zoghi, Michael M. Covell, Chase Smitterberg, Stefan T. Prvulovic, William T. DiCiurcio, Johnny Delashaw, Meic H. Schmidt, Marc D. Moisi, Christian A. Bowers Global Spine Journal.2026; 16(1): 135. CrossRef
Beyond the modified Frailty Index-5: Toward superior frailty risk measures Cameron Sabet, Bhav Jain, Hana Abbasian, Jonathan Franco Shoulder & Elbow.2026; 18(3): 646. CrossRef
Predictive value of the risk analysis index for 30-day mortality following surgical management of thoracolumbar vertebral body fractures Stefan Prvulovic, Nithin Gupta, Sina Zhogi, Charles Bowers, Kishan Shah, Alfred Marcinkowski, Anjali Gupta, Christian Bowers European Spine Journal.2026; 35(4): 1964. CrossRef
In Response to Inconsistent Associations of Modified Frailty Index‐5 With Adverse Head and Neck Reconstruction Outcomes Doruk Orgun, Samuel O. Poore The Laryngoscope.2026;[Epub] CrossRef
In Reference to Inconsistent Associations of Modified Frailty Index‐5 With Adverse Head and Neck Reconstruction Outcomes Akshay Warrier, Jeel Patel, Christian A. Bowers, Richard Gurgel The Laryngoscope.2026;[Epub] CrossRef
Frailty Screening in the Emergency Department Enables Personalized Multidisciplinary Care for Geriatric Trauma Patients Oluwafemi P. Owodunni, Tatsuya Norii, Sarah A. Moore, Sabrina L. Parks Bent, Ming-Li Wang, Cameron S. Crandall Journal of Personalized Medicine.2026; 16(2): 89. CrossRef
The importance of comprehensive geriatric assessment in predicting the outcome of patients with proximal humerus fractures Jan-Philipp Happe, J. Christoph Katthagen, Karen Fischhuber, Ursula Marschall, Andreas Faldum, Michael J. Raschke, Jeanette Koeppe, Josef Stolberg-Stolberg Aging Clinical and Experimental Research.2026;[Epub] CrossRef
Otologic Surgery Risk Prediction: Risk Analysis Index‐Administrative Versus Modified Frailty Index‐5 Akshay Warrier, Nicole Kim, Ryan Bartholomew, Liliya Benchetrit, Daniel J. Lee The Laryngoscope.2026;[Epub] CrossRef
Frailty is a Vital Tool for Predicting Outcomes Following Prophylactic Femur Fixation Omar Sbaih, Victor Koltenyuk, Nithin Gupta, Lindsey Dixon, Vikram Gill, Mallory Ogburn, Tyler K. Williamson, Joseph Alderete Journal of the American Academy of Orthopaedic Surgeons.2026;[Epub] CrossRef
Orthopedic frailty risk stratification (OFRS): a systematic review of the frailty indices predicting adverse outcomes in orthopedics Nithin K. Gupta, Forrest Dunivin, Hikmat R. Chmait, Chase Smitterberg, Azhaan Buttar, Moiz Fazal-ur-Rehman, Taylor Manes, Morgan Turnow, Tyler K. Williamson, Benjamin C. Taylor, Jack W. Weick, Christian Bowers Journal of Orthopaedic Surgery and Research.2025;[Epub] CrossRef
Utility of Revised Risk Analysis Index as a Predictor of Mortality and Morbidity in Orthopaedic Trauma Chirag Soni, Victor Koltenyuk, Nithin Gupta, Haad A. Arif, Aruni Areti, Taylor Manes, Luke A. Lopas, Jan P. Szatkowski, Christian A. Bowers, Benjamin C. Taylor, Jack W. Weick JAAOS: Global Research and Reviews.2025;[Epub] CrossRef
Risk Analysis Index for Estimation of 30-Day Postoperative Mortality in Hip Fractures Nithin K. Gupta, Hikmat R. Chmait, Vikram Gill, Morgan Turnow, Taylor Manes, Benjamin C. Taylor, Jack W. Weick, Christian Bowers JAMA Network Open.2025; 8(5): e2512689. CrossRef
Risk Analysis Index Versus Modified Frailty Index: Outcomes After Otolaryngologic Surgery Lauran K. Evans, Carine Tamamian, Desiree Delavary, Matthew E. Lin, Hong‐Ho Yang, Maie St. John, Dinesh K. Chhetri The Laryngoscope.2025; 135(12): 4655. CrossRef
Chronological and Biological Age in Predicting Outcomes of Older Patients in Neurosurgery Fusao IKAWA, Masashi KUWABARA, Nobuaki MICHIHATA, Nao ICHIHARA, Kazunori TOYODA, Nobutaka HORIE Neurologia medico-chirurgica.2025; 65(12): 541. CrossRef
The risk analysis index demonstrates exceptional discrimination in predicting frailty's impact on neurosurgical length of stay quality metrics Thomas A. Gagliardi, Joseph T. Conti, Jordyn T. Courville, Oluwafemi P. Owodunni, Evan N. Courville, Syed F. Kazim, Meic H. Schmidt, Christian A. Bowers World Journal of Surgery.2024; 48(1): 59. CrossRef
Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic Oluwafemi P. Owodunni, Evan N. Courville, Uchenna Peter-Okaka, Christian B. Ricks, Meic H. Schmidt, Christian A. Bowers International Journal of Obesity.2024; 48(3): 360. CrossRef
Letter to the Editor Regarding “Frailty Stratification Using the Modified 5-Item Frailty Index: Significant Variation Within Frailty Patients in Spine Surgery” Oluwafemi P. Owodunni, Christian A. Bowers World Neurosurgery.2024; 182: 222. CrossRef
The Weight of Frailty in Neurosurgery Patients: Analyzing the Combined Effect of Frailty and Body Mass Index on 30-Day Postoperative Mortality Robert M. Branstetter, Oluwafemi P. Owodunni, Evan N. Courville, Jordyn T. Courville, Thomas A. Gagliardi, Joseph T. Conti, Meic H. Schmidt, Christian A. Bowers World Neurosurgery.2024; 184: e449. CrossRef
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 Christopher C. Paiz, Oluwafemi P. Owodunni, Evan N. Courville, Meic Schmidt, Robert Alunday, Christian A. Bowers World Neurosurgery: X.2024; 23: 100286. CrossRef
Association Between Modified Frailty Index and Postoperative Outcomes of Cricopharyngeal Myotomy Afash Haleem, David Herz, Keshav D. Kumar, Sree R. Chinta, Dhiraj R. Sibala, Michael Hegazin, Jean Anderson Eloy Otolaryngology–Head and Neck Surgery.2024; 171(5): 1462. CrossRef
Impact of frailty on all-cause mortality in older neurosurgical patients with prolonged hospitalization: a retrospective observational study Cynthia Uzoukwu, Oluwafemi P. Owodunni, Uchenna Peter-Okaka, Evan N. Courville, Joseph T. Conti, Thomas A. Gagliardi, Meic H. Schmidt, Christian A. Bowers Aging Advances.2024; 1(2): 69. CrossRef
Objective The endoscopic spine surgery (ESS) approach is associated with high levels of patient satisfaction, shorter recovery time, and reduced complications. The present study reports multicenter, international data, comparing ESS and non-ESS approaches for singlelevel lumbar decompression, and proposes a frailty-driven predictive model for nonhome discharge (NHD) disposition.
Methods Cases of ESS and non-ESS lumbar spine decompression were queried from the American College of Surgeons National Surgical Quality Improvement Program database (2017–2020). Propensity score matching was performed on baseline characteristics frailty score (measured by risk analysis index [RAI] and modified frailty index-5 [mFI-5]). The primary outcome of interest was NHD disposition. A predictive model was built using logistic regression with RAI as the primary driver.
Results Single-level nonfusion spine lumbar decompression surgery was performed in 38,686 patients. Frailty, as measured by RAI, was a reliable predictor of NHD with excellent discriminatory accuracy in receiver operating characteristic (ROC) curve analysis: C-statistic: 0.80 (95% confidence interval [CI], 0.65–0.94) in ESS cohort, C-statistic: 0.75 (95% CI, 0.73–0.76) overall cohort. After propensity score matching, there was a reduction in total operative time (89 minutes vs. 103 minutes, p = 0.049) and hospital length of stay (LOS) (0.82 days vs. 1.37 days, p < 0.001) in patients treated endoscopically. In ROC curve analysis, the frailty-driven predictive model performed with excellent diagnostic accuracy for the primary outcome of NHD (C-statistic: 0.87; 95% CI, 0.85–0.88).
Conclusion After frailty-based propensity matching, ESS is associated with reduced operative time, shorter hospital LOS, and decreased NHD. The RAI frailty-driven model predicts NHD with excellent diagnostic accuracy and may be applied to preoperative decisionmaking with a user-friendly calculator: nsgyfrailtyoutcomeslab.shinyapps.io/lumbar_decompression_dischargedispo.
Citations
Citations to this article as recorded by
Comparison of the performance metrics of two frailty scales in spinal surgery: a systematic review and meta-analysis Carmelo VENERO Jr. Jr., Niels PACHECO-BARRIOS, Joanna M. ROY, Stefan T. PRVULOVIC, Gilberto PEREZ RODRIGUEZ GARCIA, Yusor AL-NUAIMY, Andre A. PAYMAN, Akshay WARRIER, Fielding L. HORNE, Aryan GAJJAR, Hikmat R. CHMAIT, Nithin GUPTA, Sanjeev HERR, Pemla JAGT Journal of Neurosurgical Sciences.2026;[Epub] CrossRef
Role of Frailty as Measured by the Risk Analysis Index (RAI) to Predict In-Hospital and Perioperative Outcomes in Patients Undergoing PCI: a Nationwide Study Michele Fouad, Ahmad Nawlo, Kerollos Abdelsayed, Hassan Alshaker, Kirellos Said Abbas, Abdul Rahman Akkawi, Basel Abdelazeem, Akram Kawsara Current Geriatrics Reports.2025;[Epub] CrossRef
Frailty concept in Africa neurosurgical practice: a prospective review Kehinde Alare, Habiblah Jagunmolu, Esther Adewuyi, Taiwo Oluwafemi, Peter Olaniyi, Precious Amuzat Egyptian Journal of Neurosurgery.2024;[Epub] CrossRef
Baseline Frailty Measured by the Risk Analysis Index and 30-Day Mortality After Surgery for Spinal Malignancy: Analysis of a Prospective Registry (2011–2020) Rachel Thommen, Christian A. Bowers, Aaron C. Segura, Joanna M. Roy, Meic H. Schmidt Neurospine.2024; 21(2): 404. CrossRef
Trends in degenerative lumbar spinal surgery during the early COVID-19 pandemic in Republic of Korea: A national study utilizing the national health insurance database Woon Tak Yuh, Jinhee Kim, Mi-Sook Kim, Jun-Hoe Kim, Young Rak Kim, Sum Kim, Chun Kee Chung, Chang-Hyun Lee, Sung Bae Park, Kyoung-Tae Kim, John M. Rhee, Young San Ko, Chi Heon Kim, Kentaro Yamada PLOS ONE.2024; 19(6): e0305128. CrossRef
Risk analysis index predicts mortality and non-home discharge following posterior lumbar interbody fusion: a nationwide inpatient sample analysis of 429,380 patients (2019–2020) Michael M. Covell, Kranti C. Rumalla, Shubhang Bhalla, Christian A. Bowers European Spine Journal.2024; 33(9): 3484. CrossRef
Risk Analysis Index Predicts Nonhome Discharge Following Resection of Cavernous Malformations Pemla Jagtiani, Kranti Rumalla, Joanna M. Roy, Shubhang Bhalla, Michael M. Covell, Christian A. Bowers World Neurosurgery.2024; 189: e681. CrossRef
Full-endoscopic spine-surgery in the elderly and patients with comorbidities Jannik Leyendecker, Tobias Prasse, Pia Rückels, Malin Köster, Lena Rumswinkel, Valentina Schunk, Isabella Marossa, Peer Eysel, Jan Bredow, Christoph P. Hofstetter, Imad Khan Scientific Reports.2024;[Epub] CrossRef
RAI-measured frailty predicts non-home discharge following metastatic brain tumor resection: national inpatient sample analysis of 20,185 patients Michael M. Covell, Akshay Warrier, Kranti C. Rumalla, Christopher M. Dehney, Christian A. Bowers Journal of Neuro-Oncology.2023; 164(3): 663. CrossRef
Objective To assess the discriminative ability of the Risk Analysis Index-administrative (RAI-A) and its recalibrated version (RAI-Rev), compared to the 5-factor modified frailty index (mFI-5), in predicting postoperative outcomes in patients undergoing surgical intervention for traumatic spine injuries (TSIs).
Methods The Current Procedural Terminology (CPT) and International Classification of Disease-9 (ICD-9) and ICD-10 codes were used to identify patients ≥ 18 years who underwent surgical intervention for TSI from National Surgical Quality Improvement Program (ACS-NSQIP) database 2015–2019 (n = 6,571). Multivariate analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the comparative discriminative ability of RAI-Rev, RAI-A, and mFI-5 for 30-day postoperative outcomes.
Results Multivariate regression analysis showed that with all 3 frailty scores, increasing frailty tiers resulted in worse postoperative outcomes, and patients identified as frail and severely frail using RAI-Rev and RAI-A had the highest odds of poor outcomes. In the ROC curve/C-statistics analysis for prediction of 30-day mortality and morbidity, both RAI-Rev and RAI-A outperformed mFI-5, and for many outcomes, RAI-Rev showed better discriminative performance compared to RAI-A, including mortality (p = 0.0043, DeLong test), extended length of stay (p = 0.0042), readmission (p < 0.0001), reoperation (p = 0.0175), and nonhome discharge (p < 0.0001).
Conclusion Both RAI-Rev and RAI-A performed better than mFI-5, and RAI-Rev was superior to RAI-A in predicting postoperative mortality and morbidity in TSI patients. RAI-based frailty indices can be used in preoperative risk assessment of spinal trauma patients.
Citations
Citations to this article as recorded by
Discriminatory Value of the Risk Analysis Index Versus the 5-Factor Modified Frailty Index for Major Outcome Measures in Degenerative Cervical Myelopathy Nithin K. Gupta, Sina Zoghi, Michael M. Covell, Chase Smitterberg, Stefan T. Prvulovic, William T. DiCiurcio, Johnny Delashaw, Meic H. Schmidt, Marc D. Moisi, Christian A. Bowers Global Spine Journal.2026; 16(1): 135. CrossRef
Beyond the modified Frailty Index-5: Toward superior frailty risk measures Cameron Sabet, Bhav Jain, Hana Abbasian, Jonathan Franco Shoulder & Elbow.2026; 18(3): 646. CrossRef
Commentary: Evaluating the Impact of Frailty on Mortality in Patients With Nonoperative and Operative Type II Odontoid Fracture: An American College of Surgeons Trauma Quality Improvement Program Survival Analysis of 22440 Patients Anna F. Fusco, Julie L. Chan Neurosurgery.2026; 98(1): e1. CrossRef
Predictive Value of Geriatric Nutritional Risk Index and Risk Analysis Index for Post-operative Outcomes in Spine Surgery Patients: A Comprehensive Analysis Stefan T. Prvulovic, Sina Zoghi, Aryan Gajjar, Cameron J. Sabet, Michael M. Covell, Bhavya Pahwa, Nithin Gupta, Meic H. Schmidt, Marc D. Moisi, Johnny Delashaw, Christian A. Bowers Global Spine Journal.2026; 16(2): 1177. CrossRef
In Reference to Inconsistent Associations of Modified Frailty Index‐5 With Adverse Head and Neck Reconstruction Outcomes Akshay Warrier, Jeel Patel, Christian A. Bowers, Richard Gurgel The Laryngoscope.2026;[Epub] CrossRef
Predictive value of the risk analysis index for 30-day mortality following surgical management of thoracolumbar vertebral body fractures Stefan Prvulovic, Nithin Gupta, Sina Zhogi, Charles Bowers, Kishan Shah, Alfred Marcinkowski, Anjali Gupta, Christian Bowers European Spine Journal.2026; 35(4): 1964. CrossRef
When combined frailty, anemia, and malnourishment exhibit a predictive power for 30-day outcomes following anterior cervical discectomy and fusions for cervical spondylotic myelopathy Jacob M. Gluski, Gabrielle Santangelo, Paul Serrato, Shaila Ghanekar, Ethan DL Brown, Aryaa Karkare, Aladine Elsamadicy, Sheng-fu Larry Lo, Daniel M. Sciubba Next Research.2026; 5: 101378. CrossRef
Assessing combined effects of RAI, GNRI, and Anemia on morbidity and mortality in elderly patients after subdural hematoma evacuation Shaila D. Ghanekar, Paul Serrato, Ethan D.L. Brown, Sina Sadeghzadeh, Apratim Maity, Syed I. Khalid, Michael DiLuna, Aladine A. Elsamadicy Clinical Neurology and Neurosurgery.2026; 263: 109340. CrossRef
ACDF and cervical disc replacement for single-level cervical spine degenerative disease: a frailty driven propensity score-matched comparative analysis Nithin Gupta, Omar Sbaih, William DiCiurcio III, Mark Miller, Ruchir Nanavati, Hunter Smith, Blake Delgadillo, Matthew Meade, Aman Singh, Rohin Singh, Christian Bowers European Spine Journal.2026;[Epub] CrossRef
Discriminatory Value of the Revised Risk Analysis Index Compared With the Charlson Comorbidity Index in Predicting Outcomes of Patients Undergoing Treatment for Chronic Subdural Hematoma Camron Chugg, Omid Shoraka, Diwas Gautam, David Botros, Caitlyn Wandvik, Ahmet Dalkilic, Iris Charcos, Manisha Koneru, Randall Treffy, Christina Feller, Peter Palmer, Sarah T. Menacho, John D. Nerva, Daniel A. Tonetti, Ramesh Grandhi Operative Neurosurgery.2026;[Epub] CrossRef
Otologic Surgery Risk Prediction: Risk Analysis Index‐Administrative Versus Modified Frailty Index‐5 Akshay Warrier, Nicole Kim, Ryan Bartholomew, Liliya Benchetrit, Daniel J. Lee The Laryngoscope.2026;[Epub] CrossRef
Is There an Ideal Method of Predicting Postoperative Complications Following Major Head and Neck Procedures?: A Comparative Analysis of Three Frailty Indices Michael P. Saturno, Olivia First, Diana Shaari, Rahul Guda, Christopher Connors, Raymond L. Chai Head & Neck.2026;[Epub] CrossRef
Comparison of the performance metrics of two frailty scales in spinal surgery: a systematic review and meta-analysis Carmelo VENERO Jr. Jr., Niels PACHECO-BARRIOS, Joanna M. ROY, Stefan T. PRVULOVIC, Gilberto PEREZ RODRIGUEZ GARCIA, Yusor AL-NUAIMY, Andre A. PAYMAN, Akshay WARRIER, Fielding L. HORNE, Aryan GAJJAR, Hikmat R. CHMAIT, Nithin GUPTA, Sanjeev HERR, Pemla JAGT Journal of Neurosurgical Sciences.2026;[Epub] CrossRef
Risk Analysis Index Versus mFI‐5 for Predicting Outcomes After Uvulopalatopharyngoplasty Akshay Warrier, Ariana Shaari, Aman M. Patel, Christian Bowers, Kenneth Yan The Laryngoscope.2026;[Epub] CrossRef
The risk analysis index is a better preoperative assessment tool for complication risk following an amputation due to critical limb ischemia Hannah J. Grimmett, Omar Sbaih, Hikmat R. Chmait, Connor J. Tupper, Geoffrey I. Phillips Formosan Journal of Surgery.2026; 59(3): 123. CrossRef
Risk Stratification in Periprosthetic Hip Fracture Surgery: The Risk Analysis Index Is Superior to the Five-Item Modified Frailty Index for Predicting 30-Day Complications Nick Jowkar, Maxwell Ruffner, Victor Koltenyuk, Irina D. Sokolik, Hunter Horsley, Matthew Rohl, Tyler K. Williamson, Jack W. Weick The Journal of Arthroplasty.2026;[Epub] CrossRef
Frailty Predicts Postoperative Risk Following Total Joint Arthroplasty in Patients With Metastatic Disease Aruni Areti, Rohan Rajan, Brett Barthman, Victor Koltenyuk, Hikmat Chmait, Cameron Sabet, Lucas Marchese, Tyler Williamson, Taylor J. Manes, Benjamin C. Taylor, Jack Weick Montefiore Einstein Journal of Musculoskeletal Medicine and Surgery.2026;[Epub] CrossRef
A Comparison of Frailty Indices in Predicting Postoperative Outcomes After Endoscopic Sinus Surgery Akshay Warrier, David Remyes, Tenesha Boyd, Ailish Nagpal, Aman M Patel, David W. Wassef, Jean Anderson Eloy International Forum of Allergy & Rhinology.2026;[Epub] CrossRef
Frailty and comorbidity burden predict complications after mechanical thrombectomy in Octogenarians Madeline Elizabeth Moore, Najib Muhammad, Alexander Gerlach, Jan-Karl Burkhardt Journal of Clinical Neuroscience.2026; 152: 112200. CrossRef
Assessing a revised-risk analysis index for morbidity and mortality after spine surgery for metastatic spinal tumors Aladine A. Elsamadicy, Paul Serrato, Sina Sadeghzadeh, Sumaiya Sayeed, Astrid C. Hengartner, Syed I. Khalid, Sheng-fu Larry Lo, John H. Shin, Ehud Mendel, Daniel M. Sciubba Journal of Neuro-Oncology.2025; 171(1): 213. CrossRef
Predicting morbidity and mortality after surgery for isolated traumatic spinal injury without spinal cord injury Ahmad Mohammad Ismail, Maximilian Peter Forssten, Yang Cao, Ioannis Ioannidis, Sebastian Peter Forssten, Babak Sarani, Shahin Mohseni Journal of Trauma and Acute Care Surgery.2025; 98(3): 476. CrossRef
Frailty Predicts Failure to Rescue Following Malignant Brain Tumor Resection: A National Surgical Quality Improvement Program Analysis of 14,721 Patients/ (2012–2020) Stefan T. Prvulovic, Joanna M. Roy, Akshay Warrier, Pemla Jagtiani, Joe Hirsch, Michael M. Covell, Christian A. Bowers World Neurosurgery.2025; 195: 123671. CrossRef
Predictive ability of frailty scores in surgically managed patients with traumatic spinal injuries: a TQIP analysis Maximilian Peter Forssten, Lovisa Ekestubbe, Yang Cao, Ahmad Mohammad Ismail, Ioannis Ioannidis, Babak Sarani, Shahin Mohseni European Journal of Trauma and Emergency Surgery.2025;[Epub] CrossRef
Orthopedic frailty risk stratification (OFRS): a systematic review of the frailty indices predicting adverse outcomes in orthopedics Nithin K. Gupta, Forrest Dunivin, Hikmat R. Chmait, Chase Smitterberg, Azhaan Buttar, Moiz Fazal-ur-Rehman, Taylor Manes, Morgan Turnow, Tyler K. Williamson, Benjamin C. Taylor, Jack W. Weick, Christian Bowers Journal of Orthopaedic Surgery and Research.2025;[Epub] CrossRef
Frailty and the Older Neurosurgical Patient: Assessment, Outcomes and Management Adele S. Budiansky, Dan Budiansky, Daniel I. McIsaac Current Anesthesiology Reports.2025;[Epub] CrossRef
CORR Synthesis: What Is the Impact of Frailty on Postoperative Complications After Spinal Surgery? Anant Tewari, Stephen D. Lockey Clinical Orthopaedics & Related Research.2025; 483(5): 808. CrossRef
Frailty and pituitary surgery: a systematic review Mendel Castle-Kirszbaum, Ann McCormack, Christopher Ovenden, Jeremy Kam, James King, Yi Yuen Wang, Tony Goldschlager Pituitary.2025;[Epub] CrossRef
Frailty and surgical outcomes in genitourinary prosthetic procedures: an ACS-NSQIP comparative analysis of risk indices Umar Ghaffar, Behzad Abbasi, Nizar Hakam, Adrian Fernandez, Marvin N. Carlisle, Robert Pearce, Hiren V. Patel, Kevin D. Li, Nikit Venishetty, Benjamin N. Breyer International Urology and Nephrology.2025; 57(9): 2885. CrossRef
Assessing Morbidity and Mortality in Adult Patients With Acute Traumatic Cervical Spinal Cord Injury Using a Modified Risk Analysis Index Aladine A. Elsamadicy, Paul Serrato, Selma Belkasim, Sumaiya Sayeed, Astrid C. Hengartner, Sina Sadeghzadeh, Shaila Ghanekar, Zach Pennington, Syed I. Khalid, Sheng-fu Larry Lo, Daniel M. Sciubba Neurosurgery.2025; 97(4): 829. CrossRef
Failure to Rescue After Brain Tumor Resection: A National Surgical Quality Improvement Program Analysis (2012-2020) Joanna M. Roy, Stefan T. Prvulovic, Akshay Warrier, Arash K. Mousavi, Shubhang Bhalla, Damian Sanchez, Pemla Jagtiani, Vinay Verma, Jonathan Roy Varghese, Praveen Sanmuganthan, Johnny Delashaw, Christian A. Bowers Neurosurgery.2025; 97(5): 1170. CrossRef
The risk analysis index as a predictor of 30-day mortality for elderly obese patients undergoing elective total joint arthroplasty Nithin Gupta, Jared Sasaki, Victor Koltenyuk, Amber Park, Hikmat R. Chmait, Anthony Perugini, Andrew B. Campbell Journal of Orthopaedics.2025; 65: 178. CrossRef
A Comparison of Preoperative Frailty Indices Correlation With Perioperative Risk for Patients Undergoing Sacrocolpopexy Maria J. D’Amico, Rishabh K. Simhal, Rachel C. Bernardo, Kerith R. Wang, Courtney E. Capella, Yash B. Shah, Joon Yau Leong, Patrick J. Shenot, Whitney R. Smith, Alana M. Murphy Urology.2025; 204: 59. CrossRef
Assessing combined effects of risk analysis index-revised (RAI-rev), malnutrition, and anemia on morbidity and mortality after spine surgery for metastatic spinal tumors Aladine A. Elsamadicy, Paul Serrato, Shaila D. Ghanekar, Ethan D. L. Brown, Max Ward, Zach Pennington, Daniel Schneider, Sheng-fu Larry Lo, Daniel M. Sciubba Journal of Neuro-Oncology.2025; 174(2): 527. CrossRef
Risk Analysis Index for Estimation of 30-Day Postoperative Mortality in Hip Fractures Nithin K. Gupta, Hikmat R. Chmait, Vikram Gill, Morgan Turnow, Taylor Manes, Benjamin C. Taylor, Jack W. Weick, Christian Bowers JAMA Network Open.2025; 8(5): e2512689. CrossRef
National assessment of frailty impact on endovascular mechanical thrombectomy for minor to moderately severe large vessel occlusions per NIHSS Avi A Gajjar, John Y Chen, Tarun Prabhala, Amanda Custozzo, Alan S Boulos, John C Dalfino, Nicholas C Field, Alexandra R Paul Interventional Neuroradiology.2025;[Epub] CrossRef
Utility of Revised Risk Analysis Index as a Predictor of Mortality and Morbidity in Orthopaedic Trauma Chirag Soni, Victor Koltenyuk, Nithin Gupta, Haad A. Arif, Aruni Areti, Taylor Manes, Luke A. Lopas, Jan P. Szatkowski, Christian A. Bowers, Benjamin C. Taylor, Jack W. Weick JAAOS: Global Research and Reviews.2025;[Epub] CrossRef
Assessing the predictive value of the Risk Analysis Index for short-term outcomes in acute spinal cord injury surgery Evan COURVILLE, Kranti C. RUMALLA, Joshua MARQUEZ, Joanna M. ROY, Meic H. SCHMIDT, Christian A. BOWERS Journal of Neurosurgical Sciences.2025;[Epub] CrossRef
When Is Old NOT Gold? Identifying Global Age Risk Surgical Thresholds to Improve Outcomes Komal Abdul Rahim, Kinzah Razzak Ghazi, Kantesh Kumar, Aiman Arif, Saad Bin Zafar Mahmood, Saqib Kamran Bakhshi, Hasnain Zafar, Adil Hussain Haider Journal of Surgical Research.2025; 312: 177. CrossRef
Frailty index as predictors of loss of cervical lordosis following laminoplasty in patients with cervical spondylotic myelopathy Michael Ryan Kann, Miguel A. Ruiz-Cardozo, Karma Barot, Karan Joseph, Tim Bui, Salim Yakdan, Samuel Brehm, Gabriel Trevino, Abigail Carey-Ewend, Michael Olufawo, Alexander Thomas Yahanda, Brenton Pennicooke, Camilo A. Molina Journal of Craniovertebral Junction and Spine.2025; 16(2): 148. CrossRef
Composite RAI, Malnutrition, and Anemia Model Superiorly Predicts 30-Day Morbidity and Mortality After Surgery for Adult Spinal Deformity Aladine A. Elsamadicy, Paul Serrato, Shaila D. Ghanekar, Justice Hansen, Ethan D. L. Brown, Syed I. Khalid, Daniel Schneider, Sheng-fu Larry Lo, Daniel M. Sciubba Journal of Clinical Medicine.2025; 14(15): 5379. CrossRef
Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty? Makoa Mau, Tyler Thorne, Kai Rossbach, Eleanor H. Sato, Chong Zhang, Angela P. Presson, Justin M. Haller Bone & Joint Open.2025; 6(7): 785. CrossRef
A systematic review on frailty indices utilized in oncologic surgery and radiotherapy for metastatic spine disease: A critical appraisal of components and performance Ali Haider Bangash, Rose Fluss, Sertac Kirnaz, Jason D. Nosrati, Byung-Han Rhieu, Justin Tang, Madhur K. Garg, Saikiran G. Murthy, Yaroslav Gelfand, Reza Yassari, Rafael De la Garza Ramos North American Spine Society Journal (NASSJ).2025; 24: 100794. CrossRef
Frailty assessment in acute spinal cord injury surgery: Insights from the risk analysis index and broader neurosurgical context Omar Sbaih, Stefan Prvulovic, Shubhang Bhalla, Michael Covell, Christian A. Bowers The Journal of Spinal Cord Medicine.2025; : 1. CrossRef
Risk Analysis Index Versus Modified Frailty Index: Outcomes After Otolaryngologic Surgery Lauran K. Evans, Carine Tamamian, Desiree Delavary, Matthew E. Lin, Hong‐Ho Yang, Maie St. John, Dinesh K. Chhetri The Laryngoscope.2025; 135(12): 4655. CrossRef
The revised risk analysis index outperforms the 5-factor modified frailty index in predicting postoperative morbidity after pilon fracture fixation Gabriel DeOliveira, Amber Park, Arsalaan Sayyed, Aruni Areti, Nithin Gupta, Taylor Manes, Morgan Turnow, Benjamin Taylor, Jack W. Weick Journal of Orthopaedics.2025; 70: 301. CrossRef
Patients with History of Metastasis Have Differing Surgical Indications and Increased Perioperative Risk Following Revision Total Joint Arthroplasty Aroob Zaheer, Alexander S. Vo, Guillermo Ramirez Campos, Nithin Gupta, Morgan Gable, Zachary Jodoin, Tyler K. Williamson, Frank A. Buttacavoli Geriatric Orthopaedic Surgery & Rehabilitation.2025;[Epub] CrossRef
Octogenarians and nonagenarians are at increased risk of experiencing 30-day complications following ORIF of distal radius fractures Donald MacElroy, Victor Koltenyuk, Jared Sasaki, Taylor Manes, Stephen Berling Hand Surgery and Rehabilitation.2025; 44(6): 102275. CrossRef
Comparative Analysis of Frailty Indices on Complication Risk Following Septic Revision Total Hip and Knee Arthroplasty Hannah Grimmett, Arsalaan Sayyed, Victor Koltenyuk, Aruni Areti, Hikmat R. Chmait, Nithin Gupta, Mitchell Gray, William Young, Tyler K. Williamson, Chance Moore, Frank A. Buttacavoli Geriatric Orthopaedic Surgery & Rehabilitation.2025;[Epub] CrossRef
Frailty as a predictor of postoperative outcomes in neurosurgery: a systematic review Joanna M. ROY, Syed F. KAZIM, Dylan MACCIOLA, Dante N. RANGEL, Kavelin RUMALLA, Zafar KARIMOV, Remy LINK, Javed IQBAL, Muhammad A. RIAZ, Georgios P. SKANDALAKIS, Carmelo V. VENERO, Rachel B. SIDEBOTTOM, Alis J. DICPINIGAITIS, Christian S. KASSICIEH, Omar Journal of Neurosurgical Sciences.2024;[Epub] CrossRef
Frailty in intracranial meningioma resection: the risk analysis index demonstrates strong discrimination for predicting non-home discharge and in-hospital mortality Michael M. Covell, Joanna M. Roy, Nithin Gupta, Ahmed Sami Raihane, Kranti C. Rumalla, Amanda Cyntia Lima Fonseca Rodrigues, Evan Courville, Christian A. Bowers Journal of Neuro-Oncology.2024; 169(1): 85. CrossRef
Risk analysis index predicts mortality and non-home discharge following posterior lumbar interbody fusion: a nationwide inpatient sample analysis of 429,380 patients (2019–2020) Michael M. Covell, Kranti C. Rumalla, Shubhang Bhalla, Christian A. Bowers European Spine Journal.2024; 33(9): 3484. CrossRef
Baseline Frailty Measured by the Risk Analysis Index and 30-Day Mortality After Surgery for Spinal Malignancy: Analysis of a Prospective Registry (2011–2020) Rachel Thommen, Christian A. Bowers, Aaron C. Segura, Joanna M. Roy, Meic H. Schmidt Neurospine.2024; 21(2): 404. CrossRef
Orthopedic Frailty Score and adverse outcomes in patients with surgically managed isolated traumatic spinal injury Ahmad Mohammad Ismail, Frank Hildebrand, Maximilian Peter Forssten, Marcelo A F Ribeiro, Parker Chang, Yang Cao, Babak Sarani, Shahin Mohseni Trauma Surgery & Acute Care Open.2024; 9(1): e001265. CrossRef
Comparing Frailty Indices for Risk Stratification in Urologic Oncology: Which Index to Choose? Ekamjit S. Deol, Vidit Sharma, Anthony E. Fadel, Ranveer Vasdev, Grant Henning, Spyridon Basourakos, Umar Ghaffar, Matthew K. Tollefson, Igor Frank, R. Houston Thompson, Robert J. Karnes, Stephen A. Boorjian, Abhinav Khanna Urology.2024; 194: 154. CrossRef
Utility of Risk Analysis Index for Assessing Morbidity in Patients Undergoing Posterior Spinal Fusion for Adult Spinal Deformity Aladine A. Elsamadicy, Sina Sadeghzadeh, Paul Serrato, Sumaiya Sayeed, Astrid C. Hengartner, Selma Belkasim, Syed I. Khalid, Sheng-fu Larry Lo, Daniel M. Sciubba World Neurosurgery.2024; 192: e292. CrossRef
The modified 5-item frailty index as a predictor of complications in burn patients Doha Obed, Samuel Knoedler, Mustafa Salim, Niks Gulbis, Nadjib Dastagir, Khaled Dastagir, Alperen S. Bingöl, Peter M. Vogt JPRAS Open.2023; 36: 62. CrossRef
Letter: Frailty-Based Prehabilitation for Patients Undergoing Intracranial Meningioma Resection Joanna M. Roy, Syed Faraz Kazim, Meic H. Schmidt, Christian A. Bowers Neurosurgery.2023; 92(6): e142. CrossRef
Frailty predicts hospital acquired infections after brain tumor resection: Analysis of 27,947 patients’ data from a prospective multicenter surgical registry. Albert Q. Schmidt, Salome von Euw, Joanna M. Roy, Georgios P. Skandalakis, Syed Faraz Kazim, Meic H. Schmidt, Christian A. Bowers Clinical Neurology and Neurosurgery.2023; 229: 107724. CrossRef
The Fine Line Between Simplicity and Oversimplification: Comparing the Risk Analysis Index and 5-Factor Modified Frailty Index as Frailty Assessment Tools Oluwafemi P. Owodunni, Cynthia Uzoukwu, Evan N. Courville, Meic H. Schmidt, Christian A. Bowers Neurospine.2023; 20(2): 728. CrossRef
A systematic review of predictive accuracy via c-statistic of preoperative frailty tests for extended length of stay, post-operative complications, and mortality Richard A. N. Dunlop, André Van Zundert Saudi Journal of Anaesthesia.2023; 17(4): 575. CrossRef
Role of Frailty Status in Prediction of Clinical Outcomes of Traumatic Spinal Injury: A Systematic Review and Meta-Analysis Faramarz Rohollahi, Farzin Farahbakhsh, Samuel Berchi Kankam, Mohammad Mohammadi, Aynaz Mohammadi, Rojin Korkorian, Sepehr Hobabi, Azin Moarrefdezfouli, Shervin Molavi, Benjamin M. Davies, Carl M. Zipser, Ilya Laufer, James Harrop, Paul M. Arnold, Allan R Journal of Neurotrauma.2023; 40(23-24): 2453. CrossRef
Causes and Predictors of Unplanned Readmission in Patients Undergoing Intracranial Tumor Resection: A Multicenter Analysis of 31,776 Patients Youssef M. Zohdy, Georgios P. Skandalakis, Alexander J. Kassicieh, Kavelin Rumalla, Syed Faraz Kazim, Meic H. Schmidt, Christian A. Bowers World Neurosurgery.2023; 178: e869. CrossRef
Prevalence and adverse outcomes of pre-operative frailty in patients undergoing carotid artery revascularization: a meta-analysis Zeyu Liu, Ying Yao, Meiwan Zhang, Yan Ling, Xiaoyan Yao, Min Hu Frontiers in Cardiovascular Medicine.2023;[Epub] CrossRef
A Predictive Model of Failure to Rescue After Thoracolumbar Fusion Joanna M. Roy, Aaron C. Segura, Kranti Rumalla, Georgios P. Skandalakis, Michael M. Covell, Christian A. Bowers Neurospine.2023; 20(4): 1337. CrossRef
Syed Faraz Kazim, Alis J. Dicpinigaitis, Christian A. Bowers, Smit Shah, William T. Couldwell, Rachel Thommen, Daniel J. Alvarez-Crespo, Matthew Conlon, Omar H. Tarawneh, John Vellek, Kyrill L. Cole, Jose F. Dominguez, Rohini N. Mckee, Christian B. Ricks, Peter C. Shin, Chad D. Cole, Meic H. Schmidt
Neurospine 2022;19(1):53-62. Published online February 2, 2022
Objective The present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry.
Methods The National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients’ data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5.
Results Both univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. ‘Severely frail’ patients were found to have the highest risk, with odds ratio 16.4 (95% confidence interval [CI],11.21–35.44) for 30-day mortality, 3.02 (95% CI, 1.97–4.56) for major complications, and 2.94 (95% CI, 2.32–4.21) for LOS. In ROC curve analysis, mFI-5 score (area under the curve [AUC] = 0.743) achieved superior discrimination compared to age (AUC = 0.594) for mortality.
Conclusion Increasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.
Citations
Citations to this article as recorded by
Predictive Value of Geriatric Nutritional Risk Index and Risk Analysis Index for Post-operative Outcomes in Spine Surgery Patients: A Comprehensive Analysis Stefan T. Prvulovic, Sina Zoghi, Aryan Gajjar, Cameron J. Sabet, Michael M. Covell, Bhavya Pahwa, Nithin Gupta, Meic H. Schmidt, Marc D. Moisi, Johnny Delashaw, Christian A. Bowers Global Spine Journal.2026; 16(2): 1177. CrossRef
Risk Analysis Index Outperforms the Modified Frailty Index in Predicting Outcomes in Thyroidectomy and Parathyroidectomy Akshay Warrier, Sruthi Ranganathan, Deondra Montgomery, Jonathan Tawil, Ari Istanboulli, Christian Bowers, Richard K. Gurgel, Hilary McCrary Otolaryngology–Head and Neck Surgery.2026; 174(3): 705. CrossRef
Adverse Impact of Frailty on Postoperative Outcomes of Cervical Laminoplasty Ataollah Shahbandi, Pegah Ghamasaee, Abdul Mounnem Yassin Kassab, Saman Shabani World Neurosurgery.2026; 206: 124776. CrossRef
Prognostic Scoring Systems for Burns: A Comparative Analysis of Their Predictive Accuracies for Mortality in Burn Patients Susanne Rein, Jule Schmiechen, Jochen Gille, Thomas Kremer European Burn Journal.2026; 7(1): 18. CrossRef
Geriatric Nutritional Risk Index as a Predictor of Outcomes After Spinal Deformity Surgery in Elderly Patients Ataollah Shahbandi, Kevin Wojcik, Saman Shabani Global Spine Journal.2026;[Epub] CrossRef
Intramedullary Spinal Cord Tumors in the Elderly Patient Max Ward, Ethan D.L. Brown, Apratim Maity, Sheng-Fu Larry Lo, Daniel M. Sciubba Neurosurgery Clinics of North America.2026; 37(3): 363. CrossRef
Comparison of the performance metrics of two frailty scales in spinal surgery: a systematic review and meta-analysis Carmelo VENERO Jr. Jr., Niels PACHECO-BARRIOS, Joanna M. ROY, Stefan T. PRVULOVIC, Gilberto PEREZ RODRIGUEZ GARCIA, Yusor AL-NUAIMY, Andre A. PAYMAN, Akshay WARRIER, Fielding L. HORNE, Aryan GAJJAR, Hikmat R. CHMAIT, Nithin GUPTA, Sanjeev HERR, Pemla JAGT Journal of Neurosurgical Sciences.2026;[Epub] CrossRef
Evaluating the predictive value of the modified frailty index (mFI-5) on postoperative outcomes in patients with high-grade gliomas Peter G. Zaki, Abigail McKenna, Sanjeev Herr, Lana Al Doori, Abigail Murtha, Davin Evanson, Jakob Nypaver, Nisha L. Busch, Ramee Beool, Trent Kite, Praveer Vyas, Jenna Li, Jody Leonardo, Alexander Yu, Jonathan Herbst, Stephen Karlovits, Rodney E. Wegner, Journal of Clinical Neuroscience.2026; 150: 112018. CrossRef
Racial and Ethnic Disparities in Posterior Cervical Spine Surgery Ataollah Shahbandi, Kevin Wojcik, Peter Palmer, Pegah Ghamasaee, Saman Shabani Clinical Spine Surgery.2026;[Epub] CrossRef
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 European Spine Journal.2026;[Epub] CrossRef
Surgical Intervention in Very Elderly Patients with Spinal Ependymoma: A National Cancer Database Analysis Garin Griffith, Saud K. Zaidan, Jacob Gould, Saarang Patel, Hazem S. Ghaith, Julian Gendreau, Maryam N. Shahin, Josiah N. Orina Cancers.2026; 18(12): 1927. CrossRef
Early Postoperative Adverse Events (≤ 30 Days) in Spinal Oncology: Defining the Incidence, Severity, and Predictors in a Mixed Prospective Cohort Including Intradural and Metastatic Spinal Tumors Meltem Ivren, Philip Dao Trong, Maximilian Klass, Martin Dugas, Sebastian Ille, Sandro M. Krieg, Pavlina Lenga International Journal of Cancer.2026;[Epub] CrossRef
Assessing a revised-risk analysis index for morbidity and mortality after spine surgery for metastatic spinal tumors Aladine A. Elsamadicy, Paul Serrato, Sina Sadeghzadeh, Sumaiya Sayeed, Astrid C. Hengartner, Syed I. Khalid, Sheng-fu Larry Lo, John H. Shin, Ehud Mendel, Daniel M. Sciubba Journal of Neuro-Oncology.2025; 171(1): 213. CrossRef
The 5-factor modified frailty index as a prognostic factor following stereotactic radiosurgery for metastatic disease to the brain from non-small cell lung cancer: A multi-center cohort analysis Sujay Rajkumar, Trent Kite, Jay Desai, Thomas Lucido, David Mathieu, Manjul Tripathi, Navneet Singh, Narendra Kumar, Georgios Mantziaris, Stylianos Pikis, Jason P. Sheehan, Rodney E. Wegner, Matthew J. Shepard Journal of Clinical Neuroscience.2025; 132: 110979. CrossRef
A Critical Appraisal of the Application of Frailty and Sarcopenia in the Spinal Oncology Population Mark A. MacLean, Antoinette J. Charles, Miltiadis Georgiopoulos, Jackie Phinney, Raphaële Charest-Morin, Rory Goodwin, Ilya Laufer, Michael G. Fehlings, John Shin, Nicholas Dea, Laurence D. Rhines, Arjun Sahgal, Ziya Gokaslan, Byron Stephens, Alexander C. Global Spine Journal.2025;[Epub] CrossRef
Integrated management of metastatic spinal tumors: current status and future directions Min J. Kim, Neelan J. Marianayagam, Ankush Chandra, Carlotta Ranalli, Ethan Schonfeld, Juan P. Avila-Madrigal, Ann Marie E. Flusche, Katherine Schoeffler, Safwan Alomari, Namratha B. Rao, Kelly Yoo, Fred C. Lam, David J. Park, Andrew A. Fanous, Steven D. Medical Oncology.2025;[Epub] CrossRef
Letter: Surgical Fixation of Thoracolumbar Fractures in Patients Older Than 80 Years Michael M. Covell, Shubhang Bhalla, Christian A. Bowers Neurosurgery.2025; 97(1): e38. CrossRef
Frailty predicts non-home discharge in anterior lumbar interbody fusion patients Derek B. ASSERSON, Danielle A. ALAOUIEH, Joanna M. ROY, Meic H. SCHMIDT, Christian A. BOWERS Journal of Neurosurgical Sciences.2025;[Epub] CrossRef
The dynamic nature of frailty in metastatic spine disease patients Oludotun Ogunsola, Edward S. Harake, Sean Smith, Michael Albdewi, Varun Kathawate, Sebele Ogunsola, William Jackson, Joseph Evans, Vikram Chakravarthy, Nicholas Szerlip Journal of Neuro-Oncology.2025; 175(3): 1247. CrossRef
Frailty as a Predictor of Post-Surgical Outcomes in Patients With Cutaneous Malignancies of the Scalp and Neck Requiring Flap Reconstruction Christopher Welch, Syed Faraz Kazim, Antoinette Esce, Christian Bowers, Noah Syme, Nathan Boyd Annals of Otology, Rhinology & Laryngology.2024; 133(1): 7. CrossRef
Frailty: Implications for Neuroanesthesia Amy Mitchell, Alana M. Flexman Journal of Neurosurgical Anesthesiology.2024; 36(2): 95. CrossRef
The Evolution of Risk Assessment in Spine Surgery: A Narrative Review Andy Ton, Danielle Wishart, Jacob R. Ball, Ishan Shah, Kiley Murakami, Matthew P. Ordon, R. Kiran Alluri, Raymond Hah, Michael M. Safaee World Neurosurgery.2024; 188: 1. CrossRef
Baseline Frailty Measured by the Risk Analysis Index and 30-Day Mortality After Surgery for Spinal Malignancy: Analysis of a Prospective Registry (2011–2020) Rachel Thommen, Christian A. Bowers, Aaron C. Segura, Joanna M. Roy, Meic H. Schmidt Neurospine.2024; 21(2): 404. CrossRef
Risk analysis index predicts mortality and non-home discharge following posterior lumbar interbody fusion: a nationwide inpatient sample analysis of 429,380 patients (2019–2020) Michael M. Covell, Kranti C. Rumalla, Shubhang Bhalla, Christian A. Bowers European Spine Journal.2024; 33(9): 3484. CrossRef
The Fragile Brain: Understanding Frailty in Neuroanesthesia Joseph N. Monteiro, Nimisha Thakur, Shwetal Goraksha Journal of Neuroanaesthesiology and Critical Care.2024; 11(03): 179. CrossRef
Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age Alexandria F. Naftchi, John Vellek, Julia Stack, Eris Spirollari, Sima Vazquez, Ankita Das, Jacob D. Greisman, Zehavya Stadlan, Omar H. Tarawneh, Sabrina Zeller, Jose F. Dominguez, Merritt D. Kinon, Chirag D. Gandhi, Syed Faraz Kazim, Meic H. Schmidt, Chr Dysphagia.2023; 38(3): 837. CrossRef
Hospital-acquired infection following spinal tumor surgery: A frailty-driven pre-operative risk model Christian S. Kassicieh, Alexander J. Kassicieh, Kavelin Rumalla, Evan N. Courville, Kyril L. Cole, Syed Faraz Kazim, Christian A. Bowers, Meic H. Schmidt Clinical Neurology and Neurosurgery.2023; 225: 107591. CrossRef
Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model Alexander J. Kassicieh, Kavelin Rumalla, Aaron C. Segura, Syed Faraz Kazim, John Vellek, Meic H. Schmidt, Peter C. Shin, Christian A. Bowers Neurospine.2023; 20(1): 119. CrossRef
Prospective application of the risk analysis index to measure preoperative frailty in spinal tumor surgery: A single center outcomes analysis Remy L. Link, Kavelin Rumalla, Evan N. Courville, Joanna M. Roy, Syed Faraz Kazim, Christian A. Bowers, Meic H. Schmidt World Neurosurgery: X.2023; 19: 100203. CrossRef
Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes Addi N. Moya, Oluwafemi P. Owodunni, Joshua L. Harrison, Shawhin R. Shahriari, Anil K. Shetty, Gregory L. Borah, Meic H. Schmidt, Christian A. Bowers Plastic and Reconstructive Surgery - Global Open.2023; 11(6): e5059. CrossRef
The Fine Line Between Simplicity and Oversimplification: Comparing the Risk Analysis Index and 5-Factor Modified Frailty Index as Frailty Assessment Tools Oluwafemi P. Owodunni, Cynthia Uzoukwu, Evan N. Courville, Meic H. Schmidt, Christian A. Bowers Neurospine.2023; 20(2): 728. CrossRef
The Utility of the 5 Factor Modified Frailty Index in Outcome Prediction for Patients with Chronic Subdural Hematoma Treated with Surgical Drainage Peter G. Zaki, John Bolger, Brandon Rogowski, Nisha Busch, Shahed Elhamdani, Seung Jeong, Jenna Li, Jody Leonardo, Richard Williamson, Alexander Yu, Matthew J. Shepard World Neurosurgery.2023; 179: e328. CrossRef
The Risk Analysis Index Has Superior Discrimination Compared With the Modified Frailty Index-5 in Predicting Worse Postoperative Outcomes for the Octogenarian Neurosurgical Patient Alyssa G. Yocky, Oluwafemi P. Owodunni, Evan N. Courville, Syed Faraz Kazim, Meic H. Schmidt, Susan L. Gearhart, Diana L. Greene-Chandos, Naomi George, Christian A. Bowers Neurosurgery Practice.2023;[Epub] CrossRef
Commentary on “Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients” Moon-Jun Sohn Neurospine.2022; 19(1): 63. CrossRef
Use of the 5-Factor Modified Frailty Index to Predict Hospital-Acquired Infections and Length of Stay Among Neurotrauma Patients Undergoing Emergent Craniotomy/Craniectomy Kyril L. Cole, Elena Kurudza, Masum Rahman, Syed Faraz Kazim, Meic H. Schmidt, Christian A. Bowers, Sarah T. Menacho World Neurosurgery.2022; 164: e1143. CrossRef
Worse cranial neurosurgical outcomes predicted by increasing frailty in patients with interhospital transfer status: Analysis of 47,736 patients from the National Surgical Quality Improvement Program (NSQIP) 2015–2019 Alexander J. Kassicieh, Samantha Varela, Kavelin Rumalla, Syed Faraz Kazim, Kyril L. Cole, Desna V. Ghatalia, Meic H. Schmidt, Christian A. Bowers Clinical Neurology and Neurosurgery.2022; 221: 107383. CrossRef
Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis Rachel Thommen, Syed Faraz Kazim, Kavelin Rumalla, Alexander J. Kassicieh, Piyush Kalakoti, Meic H. Schmidt, Rohini G. McKee, Daniel E. Hall, Richard J. Miskimins, Christian A. Bowers Journal of Neuro-Oncology.2022; 160(2): 285. CrossRef
The Frailty Phenotype in Older Adults Undergoing Cochlear Implantation Emily Kay-Rivest, David R. Friedmann, Sean O. McMenomey, Daniel Jethanamest, J. Thomas Roland, Susan B. Waltzman Otology & Neurotology.2022; 43(10): e1085. CrossRef
Preoperative risk model for perioperative stroke after intracranial tumor resection: ACS NSQIP analysis of 30,951 cases Alexander J. Kassicieh, Kavelin Rumalla, Syed Faraz Kazim, Derek B. Asserson, Meic H. Schmidt, Christian A. Bowers Neurosurgical Focus.2022; 53(6): E9. CrossRef
First
Prev
