Superior discrimination of the Risk Analysis Index compared with the 5-item modified frailty index in 30-day outcome prediction after anterior cervical discectomy and fusion
OBJECTIVE: The objective of this paper was to compare the predictive ability of the recalibrated Risk Analysis Index (RAI-rev) with the 5-item modified frailty index-5 (mFI-5) for postoperative outcomes of anterior cervical discectomy and fusion (ACDF).
METHODS: This study was performed using data of adult (age > 18 years) ACDF patients obtained from the National Surgical Quality Improvement Program database during the years 2015-2019. Multivariate modeling and receiver operating characteristic (ROC) curve analysis, including area under the curve/C-statistic calculation with the DeLong test, were performed to evaluate the comparative discriminative ability of the RAI-rev and mFI-5 for 5 postoperative outcomes.
RESULTS: Both the RAI-rev and mFI-5 were independent predictors of increased postoperative mortality and morbidity in a cohort of 61,441 ACDF patients. In the ROC analysis for 30-day mortality prediction, C-statistics indicated a significantly better performance of the RAI-rev (C-statistic = 0.855, 95% CI 0.852-0.858) compared with the mFI-5 (C-statistic = 0.684, 95% CI 0.680-0.688) (p < 0.001, DeLong test). The results were similar for postoperative ACDF morbidity, Clavien-Dindo grade IV complications, nonhome discharge, and reoperation, demonstrating the superior discriminative ability of the RAI-rev compared with the mFI-5.
CONCLUSIONS: The RAI-rev demonstrates superior discrimination to the mFI-5 in predicting postoperative ACDF mortality and morbidity. To the authors' knowledge, this is the first study to document frailty as an independent risk factor for postoperative mortality after ACDF. The RAI-rev has conceptual fidelity to the frailty phenotype and may be more useful than the mFI-5 in preoperative ACDF risk stratification. Prospective validation of these findings is necessary, but patients with high RAI-rev scores may benefit from knowing that they might have an increased surgical risk for ACDF morbidity and mortality.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
|---|---|
| Enthalten in: |
Journal of neurosurgery. Spine - 39(2023), 4 vom: 01. Okt., Seite 509-519 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Bowers, Christian A [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
5-item modified frailty index |
|---|
| Anmerkungen: |
Date Revised 01.10.2023 published: Electronic-Print Citation Status Publisher |
|---|
| doi: |
10.3171/2023.5.SPINE221020 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM359402542 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM359402542 | ||
| 003 | DE-627 | ||
| 005 | 20231226080808.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.3171/2023.5.SPINE221020 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1197.xml |
| 035 | |a (DE-627)NLM359402542 | ||
| 035 | |a (NLM)37439459 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Bowers, Christian A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Superior discrimination of the Risk Analysis Index compared with the 5-item modified frailty index in 30-day outcome prediction after anterior cervical discectomy and fusion |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 01.10.2023 | ||
| 500 | |a published: Electronic-Print | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a OBJECTIVE: The objective of this paper was to compare the predictive ability of the recalibrated Risk Analysis Index (RAI-rev) with the 5-item modified frailty index-5 (mFI-5) for postoperative outcomes of anterior cervical discectomy and fusion (ACDF) | ||
| 520 | |a METHODS: This study was performed using data of adult (age > 18 years) ACDF patients obtained from the National Surgical Quality Improvement Program database during the years 2015-2019. Multivariate modeling and receiver operating characteristic (ROC) curve analysis, including area under the curve/C-statistic calculation with the DeLong test, were performed to evaluate the comparative discriminative ability of the RAI-rev and mFI-5 for 5 postoperative outcomes | ||
| 520 | |a RESULTS: Both the RAI-rev and mFI-5 were independent predictors of increased postoperative mortality and morbidity in a cohort of 61,441 ACDF patients. In the ROC analysis for 30-day mortality prediction, C-statistics indicated a significantly better performance of the RAI-rev (C-statistic = 0.855, 95% CI 0.852-0.858) compared with the mFI-5 (C-statistic = 0.684, 95% CI 0.680-0.688) (p < 0.001, DeLong test). The results were similar for postoperative ACDF morbidity, Clavien-Dindo grade IV complications, nonhome discharge, and reoperation, demonstrating the superior discriminative ability of the RAI-rev compared with the mFI-5 | ||
| 520 | |a CONCLUSIONS: The RAI-rev demonstrates superior discrimination to the mFI-5 in predicting postoperative ACDF mortality and morbidity. To the authors' knowledge, this is the first study to document frailty as an independent risk factor for postoperative mortality after ACDF. The RAI-rev has conceptual fidelity to the frailty phenotype and may be more useful than the mFI-5 in preoperative ACDF risk stratification. Prospective validation of these findings is necessary, but patients with high RAI-rev scores may benefit from knowing that they might have an increased surgical risk for ACDF morbidity and mortality | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a 5-item modified frailty index | |
| 650 | 4 | |a age | |
| 650 | 4 | |a anterior cervical discectomy and fusion | |
| 650 | 4 | |a recalibrated Risk Analysis Index | |
| 650 | 4 | |a surgical outcomes | |
| 700 | 1 | |a Varela, Samantha |e verfasserin |4 aut | |
| 700 | 1 | |a Naftchi, Alexandria F |e verfasserin |4 aut | |
| 700 | 1 | |a Kazim, Syed Faraz |e verfasserin |4 aut | |
| 700 | 1 | |a Hall, Daniel E |e verfasserin |4 aut | |
| 700 | 1 | |a Ng, Christina |e verfasserin |4 aut | |
| 700 | 1 | |a Rawanduzy, Cameron |e verfasserin |4 aut | |
| 700 | 1 | |a Spirollari, Eris |e verfasserin |4 aut | |
| 700 | 1 | |a Vazquez, Sima |e verfasserin |4 aut | |
| 700 | 1 | |a Das, Ankita |e verfasserin |4 aut | |
| 700 | 1 | |a Graifman, Gillian |e verfasserin |4 aut | |
| 700 | 1 | |a Asserson, Derek B |e verfasserin |4 aut | |
| 700 | 1 | |a Dominguez, Jose F |e verfasserin |4 aut | |
| 700 | 1 | |a Kinon, Merritt D |e verfasserin |4 aut | |
| 700 | 1 | |a Schmidt, Meic H |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of neurosurgery. Spine |d 2004 |g 39(2023), 4 vom: 01. Okt., Seite 509-519 |w (DE-627)NLM149726244 |x 1547-5646 |7 nnns |
| 773 | 1 | 8 | |g volume:39 |g year:2023 |g number:4 |g day:01 |g month:10 |g pages:509-519 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.3171/2023.5.SPINE221020 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 39 |j 2023 |e 4 |b 01 |c 10 |h 509-519 | ||