Recalibration and External Validation of the Risk Analysis Index: A Surgical Frailty Assessment Tool

Objective and Background: The 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. Methods: The 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). Results: Recalibrating 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
Source: Annals of Surgery - Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research