Redefining Risk Assessment for Upper Extremity Amputation in Male Diabetic Patients: A National Analysis of Outcomes Using ACS-NSQIP Data (2015–2021)

Redefining Risk Assessment for Upper Extremity Amputation in Male Diabetic Patients: A National Analysis of Outcomes Using ACS-NSQIP Data (2015–2021) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Redefining Risk Assessment for Upper Extremity Amputation in Male Diabetic Patients: A National Analysis of Outcomes Using ACS-NSQIP Data (2015–2021) Cameron Sabet, Bhav Jain, Arnav Ajay Jadav, Jonathan Franco This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6781675/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Upper extremity amputation in diabetic male patients presents a high-risk surgical scenario with substantial morbidity. Traditional risk models often fail to capture the multifactorial complexity of this population. This study aimed to validate the Combined ASA–RAI–Preoperative Acute Severe Condition (CARP) score as a composite frailty index to improve risk stratification. Methods: A retrospective cohort study was performed using the ACS-NSQIP database (2015–2021). Adult male diabetic patients undergoing upper extremity amputation were identified using CPT codes. Patients with cancer, infection, emergency surgery, age ≥90, or missing data were excluded. Frailty indices including RAI, ASA, PACS, GNRI, and mFI-5 were analyzed. Multivariable logistic regression and AUROC analysis were used to evaluate predictive performance. Results: Among 829 patients, PACS and GNRI were the strongest individual predictors of adverse outcomes. The CARP score outperformed all individual indices across major complications (AUROC 0.748), mortality (2.17%), non-home discharge (11.1%), and extended length of stay (23.2%). Bootstrap validation confirmed minimal optimism bias. Conclusion: The CARP score offers superior predictive accuracy for adverse postoperative outcomes in diabetic male patients undergoing upper extremity amputation and should be considered for clinical implementation. Figures Figure 1 INTRODUCTION Upper extremity amputations represent a significant surgical burden in the United States, with diabetic patients comprising a substantial proportion of cases requiring these procedures due to complications of peripheral vascular disease and infection. The aging population and increasing prevalence of diabetes mellitus have contributed to rising surgical volumes, with these procedures carrying substantial morbidity and mortality risks that disproportionately affect older patients with multiple comorbidities. Effective preoperative risk stratification has become increasingly crucial for optimizing surgical outcomes, guiding shared decision-making between patients and surgeons, and improving resource allocation in healthcare systems. The complexity of managing diabetic patients undergoing upper extremity amputation necessitates comprehensive assessment tools that can accurately predict postoperative complications and guide perioperative care strategies. Current risk stratification tools in surgical practice include individual measures such as the Risk Analysis Index (RAI), which has demonstrated predictive validity for mortality and discharge disposition in vascular surgery patients [ 1 ], and frailty indices like the modified 5-item frailty index (mFI-5), which has shown effectiveness in predicting complications across various surgical specialties including upper extremity procedures [ 2 – 4 ]. The Geriatric Nutritional Risk Index (GNRI) provides additional nutritional assessment capabilities that complement frailty measures in surgical risk prediction. However, despite extensive research demonstrating the individual utility of these tools across orthopedic surgery [ 5 ], plastic surgery [ 6 ], and vascular procedures [ 7 , 8 ], significant limitations persist in their application to upper extremity amputation patients. Studies have shown that while individual frailty measures can predict specific outcomes such as functional independence loss [ 6 ] and reoperation rates [ 9 ], no comprehensive composite scoring system has been validated specifically for this high-risk population. A critical gap exists in the current literature regarding the combined analysis of multiple validated risk indices for predicting adverse outcomes following upper extremity amputation in diabetic patients. While previous investigations have examined individual risk factors in isolation [ 10 , 11 ], there remains an unmet need for a comprehensive composite risk stratification tool that integrates frailty, nutritional status, and acute severity measures to provide superior predictive accuracy. Therefore, this study aims to develop and validate the Combined ASA-RAI-Preoperative Acute Severe Condition (CARP) score, a novel composite risk assessment tool, and compare its predictive performance against established individual risk indices for postoperative outcomes in male diabetic patients undergoing upper extremity amputation. Methods Data Source and Patient Consent Patient data was extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database covering the period from 2015 to 2021. The ACS NSQIP is a validated, multi-institutional registry that encompasses over 700 hospitals and captures more than 200 variables related to preoperative risk factors, intraoperative variables, and 30-day postoperative outcomes. This study was conducted in compliance with HIPAA regulations and was exempt from institutional review board approval due to the retrospective nature of the deidentified data. Informed consent was waived given the retrospective design and use of publicly available deidentified data. Patient Selection Adult male diabetic patients aged 18 years or older who underwent upper extremity amputation procedures were identified using Current Procedural Terminology codes 25900, 25905, 25920, 25927, 26910, 26951, and 26952. Exclusion criteria included patients aged 90 years or older (top-coded as 90), those with diagnoses of cancer or infection, missing data on critical outcomes including mortality, discharge destination, functional status, or transfer status, emergency procedures, and incomplete frailty-related variables. Additional exclusions were made for patients with missing operative time, ASA classification, elective surgery status, length of stay, sex, race, or age data. After applying all inclusion and exclusion criteria, the final analytic cohort comprised 829 patients. Risk Indices The Risk Analysis Index (RAI) was calculated to assess frailty using age, sex, renal impairment, dyspnea, cancer status, weight loss, and functional status as key variables. Patients were categorized into frailty tiers as robust (RAI ≤ 20), normal (RAI 21–30), frail (RAI 31–40), and very frail (RAI ≥ 41). The Geriatric Nutritional Risk Index (GNRI) was calculated as GNRI = (1.489 × serum albumin [g/L]) + (41.7 × [weight/ideal body weight]), where ideal body weight was determined using the Devine formula with weight ratios capped at 1.0 for overweight patients. GNRI categories included normal (≥ 98), mild malnutrition (92-97.9), moderate malnutrition (82-91.9), and severe malnutrition (< 82). The American Society of Anesthesiologists classification (I-no disturbance, II-mild systemic disease, III-severe systemic disease, IV-life-threatening disease) was used for preoperative risk stratification. The Modified Frailty Index-5 incorporated functional dependence, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, and hypertension requiring medication. The Combined ASA-RAI-Preoperative Acute Severe Condition (CARP) score was derived from multivariable logistic regression using weighted coefficients from each risk index with internal validation performed using 100 bootstrap replications. Statistical Analysis Continuous variables were presented as mean ± standard deviation with distribution assessed using the Kolmogorov-Smirnov test. Categorical variables were compared using chi-square tests, while the Kruskal-Wallis test was used for non-normally distributed continuous variables across frailty quartiles. Multivariable logistic regression models were constructed to identify predictors of adverse outcomes using adjusted odds ratios and 95% confidence intervals. Receiver operating characteristic curve analysis assessed model discrimination with C-statistics, and the DeLong test compared predictive performances between models. Internal validation employed 100 bootstrap replications with replacement to evaluate the stability and robustness of the CARP score. All statistical analyses were performed using Stata MP Version 18 in the Redivis computing environment with statistical significance set at p < 0.05. Results Patient Characteristics A total of 1,214 patients were initially identified from the ACS-NSQIP database, with 385 patients excluded due to missing frailty-related variables (n = 156), cancer or infection diagnoses (n = 130), age ≥ 90 years (n = 8), emergency procedures (n = 26), and other missing essential data (n = 65), resulting in a final analytic cohort of 829 patients. The cohort was entirely male (n = 829, 100%) with a mean age of 58.84 years (SD 11.36). The racial distribution included 607 White patients (73.22%), 161 Black or African American patients (19.42%), 43 Asian/Pacific Islander patients (5.19%), and 18 American Indian or Alaska Native patients (2.17%). Mean body mass index was 31.33 kg/m² (SD 8.69), mean total hospital length of stay was 4.14 days (SD 6.75), and mean operative time was 41.49 minutes (SD 33.56). Regarding functional status, 678 patients (84.01%) were functionally independent, 104 patients (12.89%) were partially dependent, and 25 patients (3.10%) were totally dependent. Diabetes mellitus was present in all patients by study design, with 598 patients (72.14%) having insulin-dependent diabetes and 231 patients (27.86%) having non-insulin-dependent diabetes. Additional comorbidities included hypertension requiring medication in 635 patients (76.60%), chronic obstructive pulmonary disease in 67 patients (8.08%), congestive heart failure in 53 patients (6.39%), bleeding disorders in 159 patients (19.18%), chronic steroid use in 52 patients (6.27%), dyspnea on moderate exertion or at rest in 78 patients (9.41%), current smoking in 210 patients (25.33%), renal impairment in 45 patients (5.43%), and recent weight loss in 17 patients (2.05%). ASA classification showed 4 patients (0.48%) as ASA I, 79 patients (9.53%) as ASA II, 480 patients (57.90%) as ASA III, and 266 patients (32.09%) as ASA IV. Univariate Analysis and Risk Stratification Modified Frailty Index-5 (mFI-5) scores ranged from 0 to 5, with tier distribution showing 54 patients (6.51%) as not frail, 243 patients (29.31%) as prefrail, 367 patients (44.27%) as frail, and 165 patients (19.90%) as severely frail. Risk Analysis Index (RAI) scores ranged from 4 to 46 points, with 522 patients (62.97%) classified as not frail (≤ 20 points), 248 patients (29.92%) as prefrail (21–30 points), 54 patients (6.51%) as frail (31–40 points), and 5 patients (0.60%) as severely frail (≥ 41 points). Geriatric Nutritional Risk Index (GNRI) scores were available for 519 patients, with tier distribution showing 134 patients (16.16%) at major risk (< 82), 149 patients (17.97%) at moderate risk (82–91), 133 patients (16.04%) at low risk (92–98), and 413 patients (49.82%) at no risk (≥ 99). Preoperative Acute Severe Condition (PACS) scores were available for 784 patients with mean score of 0.54 (SD 0.74). In univariate analysis, mFI-5 score was significantly associated with major complications (OR 1.42, 95% CI 1.13–1.78, p = 0.003), extended length of stay (OR 1.37, 95% CI 1.15–1.64, p < 0.001), unplanned reoperation (OR 1.34, 95% CI 1.06–1.70, p = 0.015), and non-home discharge (OR 1.71, 95% CI 1.36–2.14, p < 0.001). RAI score demonstrated significant associations with extended length of stay (OR 1.04, 95% CI 1.02–1.06, p = 0.001) and non-home discharge (OR 1.10, 95% CI 1.07–1.14, p < 0.001). PACS score showed the strongest univariate associations with major complications (OR 2.69, 95% CI 2.06–3.53, p < 0.001), minor complications (OR 2.76, 95% CI 1.22–6.24, p = 0.015), unplanned readmission (OR 1.45, 95% CI 1.13–1.87, p = 0.004), unplanned reoperation (OR 1.38, 95% CI 1.05–1.82, p = 0.022), extended length of stay (OR 1.98, 95% CI 1.53–2.57, p < 0.001), and non-home discharge (OR 1.94, 95% CI 1.46–2.58, p < 0.001). ASA classification was significantly associated with major complications (OR 2.37, 95% CI 1.61–3.49, p < 0.001), unplanned readmission (OR 1.94, 95% CI 1.33–2.83, p = 0.001), unplanned reoperation (OR 1.84, 95% CI 1.19–2.84, p = 0.006), extended length of stay (OR 1.65, 95% CI 1.23–2.21, p = 0.001), and non-home discharge (OR 2.37, 95% CI 1.61–3.49, p < 0.001). Multivariable Analysis After adjustment for all frailty indices in multivariable models, PACS score remained the most robust predictor across multiple outcomes. For major complications, PACS score (OR 2.74, 95% CI 2.01–3.73, p < 0.001), GNRI score (OR 0.96, 95% CI 0.94–0.99, p = 0.003), and RAI score (OR 0.94, 95% CI 0.89–0.99, p = 0.010) were independently significant, while mFI-5 score (OR 1.04, 95% CI 0.76–1.41, p = 0.823) and ASA classification (OR 1.65, 95% CI 1.07–2.55, p = 0.025) were not independently predictive. For unplanned readmission, RAI score (OR 0.95, 95% CI 0.91-1.00, p = 0.030) and ASA classification (OR 1.80, 95% CI 1.12–2.89, p = 0.015) remained significant predictors. For unplanned reoperation, only GNRI score (OR 0.97, 95% CI 0.94-1.00, p = 0.028) maintained independent significance. For extended length of stay, PACS score (OR 1.66, 95% CI 1.26–2.20, p < 0.001) and GNRI score (OR 0.95, 95% CI 0.93–0.97, p < 0.001) were independently predictive. For non-home discharge, RAI score (OR 1.06, 95% CI 1.02–1.12, p = 0.009), PACS score (OR 1.47, 95% CI 1.05–2.06, p = 0.027), and GNRI score (OR 0.94, 95% CI 0.91–0.96, p < 0.001) remained independently significant. Major Postoperative Outcomes and Risk Stratification Overall 30-day mortality was 2.17% (n = 18). Major complications occurred in 92 patients (11.10%), with rates varying significantly by GNRI tier: major risk 19.4%, moderate risk 21.5%, low risk 11.3%, and no risk 4.6% (p < 0.001). Minor complications occurred in 4 patients (0.48%), with rates by GNRI tier of 2.2%, 0%, 0%, and 0.2% respectively (p = 0.015). Unplanned readmission occurred in 113 patients (13.63%) with GNRI tier rates of 23.1%, 16.1%, 13.5%, and 9.7% respectively (p = 0.001). Unplanned reoperation occurred in 84 patients (10.13%) with GNRI tier rates of 17.2%, 14.8%, 9.0%, and 6.5% respectively (p = 0.001). Extended length of stay (> 75th percentile of 6 days) occurred in 192 patients (23.16%) with GNRI tier rates of 43.3%, 36.9%, 20.3%, and 12.6% respectively (p < 0.001). Non-home discharge occurred in 91 patients (11.08%) with GNRI tier rates of 26.5%, 16.2%, 7.6%, and 5.4% respectively (p < 0.001). When stratified by RAI tier, mortality rates were 1.0% for not frail, 1.6% for prefrail, 13.0% for frail, and 40.0% for severely frail patients (p < 0.001). Major complication rates by RAI tier were 10.0%, 14.1%, 9.3%, and 0% respectively (p = 0.287). Extended length of stay rates were 20.1%, 26.2%, 35.2%, and 60.0% respectively (p = 0.007). Non-home discharge rates were 6.5%, 16.0%, 26.4%, and 100% respectively (p < 0.001). Novel Combined ASA-RAI-Preoperative Acute Severe Condition (CARP) Score The novel CARP score was derived from multivariable regression coefficients: CARP = (β_RAI × RAI_score) + (β_PACS × PACS_score) + (β_ASA × ASA_category), where β_RAI = -0.038, β_PACS = 1.006, and β_ASA = 0.536. This composite score demonstrated superior discriminative ability compared to individual indices for most outcomes. The CARP score achieved area under the receiver operating characteristic curve (AUROC) values of 0.748 (95% CI 0.687–0.795) for major complications, 0.819 (95% CI 0.680–0.942) for minor complications, 0.620 (95% CI 0.550–0.678) for unplanned readmission, 0.593 (95% CI 0.512–0.662) for unplanned reoperation, 0.643 (95% CI 0.589–0.685) for extended length of stay, and 0.613 (95% CI 0.549–0.674) for non-home discharge. Main Results and Performance Comparison Direct comparison of AUROC values revealed PACS as the best individual predictor for major complications (AUROC 0.726, 95% CI 0.667–0.770), significantly outperforming mFI-5 (AUROC 0.588, p < 0.001), RAI (AUROC 0.550, p < 0.001), and ASA classification (AUROC 0.625, p < 0.001) but not significantly different from CARP (p = 0.403). For minor complications, PACS achieved the highest discrimination (AUROC 0.843, 95% CI 0.711–0.958), not significantly different from CARP (p = 0.715). RAI demonstrated superior performance for non-home discharge (AUROC 0.686, 95% CI 0.630–0.740) compared to other individual indices. CARP consistently ranked among the top two predictors for all outcomes, demonstrating the value of the composite approach. Internal Validation Bootstrap validation with 100 replications was performed for all frailty indices across all outcomes. Bias-corrected AUROC values with 95% confidence intervals were: for major complications, mFI-5 0.583 (0.521–0.644), RAI 0.544 (0.481–0.608), PACS 0.719 (0.667–0.770), CARP 0.741 (0.687–0.795), and ASA 0.619 (0.566–0.671). For extended length of stay, bias-corrected values were mFI-5 0.577 (0.533–0.621), RAI 0.557 (0.504–0.609), PACS 0.624 (0.576–0.672), CARP 0.637 (0.589–0.685), and ASA 0.568 (0.528–0.608). For non-home discharge, bias-corrected values were mFI-5 0.583 (0.515–0.650), RAI 0.541 (0.479–0.603), PACS 0.577 (0.512–0.642), CARP 0.587 (0.512–0.662), and ASA 0.587 (0.531–0.644). Optimism bias was minimal across all models, ranging from 0.005 to 0.008, indicating robust internal validity and minimal overfitting. DISCUSSION Why We Conducted This Study The increasing prevalence of diabetes mellitus and its associated complications has led to a substantial rise in upper extremity amputations, particularly among vulnerable populations with multiple comorbidities. Frailty assessments have emerged as critical tools for preoperative risk stratification, with established utility in predicting adverse outcomes following major surgical procedures [ 12 , 13 ]. However, existing frailty indices have primarily been validated in lower extremity amputation populations, with limited evidence regarding their predictive accuracy in upper extremity procedures. Furthermore, no composite scoring system has been developed to integrate multiple frailty domains with acute physiologic derangements for this specific population. The development of a novel Combined ASA-RAI-Preoperative Acute Severe Condition (CARP) score addresses this critical gap by providing a comprehensive risk assessment tool that incorporates frailty, functional status, and acute illness severity to optimize perioperative decision-making for diabetic male patients undergoing upper extremity amputation. Summary of Key Findings Our analysis of 829 diabetic male patients demonstrated that the novel CARP score consistently outperformed individual frailty indices in predicting major postoperative complications, achieving superior discriminative ability with an AUROC of 0.748 (95% CI 0.687–0.795) compared to traditional indices. The PACS component emerged as the strongest individual predictor, with odds ratios exceeding 2.7 for major complications across both univariate and multivariable analyses. Risk stratification revealed striking disparities, with severely frail patients (RAI ≥ 41) experiencing 40% 30-day mortality compared to 1.0% in robust patients, while patients with major nutritional risk (GNRI < 82) demonstrated 19.4% major complication rates versus 4.6% in those without nutritional risk. The composite CARP score maintained robust predictive accuracy across all outcomes after bootstrap validation, with minimal optimism bias ranging from 0.005 to 0.008, indicating excellent internal validity and reproducibility. Literature Context and Validation Our findings align with extensive literature demonstrating the prognostic value of frailty assessments in amputation surgery, though most prior studies have focused on lower extremity procedures. Cotton et al. reported comparable mortality stratification using RAI scores in lower extremity amputation, with 1-year mortality rates of 8% for non-frail versus 43% for very frail patients, similar to our observed 30-day mortality patterns [ 12 ]. The simplified mFI-5 index validation by Pandit et al. in 8,681 geriatric patients undergoing lower limb amputation demonstrated strong predictive ability for mortality and complications, consistent with our findings showing significant associations between mFI-5 scores and multiple adverse outcomes [ 13 ]. However, our study extends these findings to upper extremity procedures in a predominantly middle-aged diabetic male population, representing a unique demographic with distinct risk profiles. The superior performance of PACS over traditional frailty indices in our cohort reflects the importance of acute physiologic derangements in determining surgical outcomes, particularly in diabetic patients with complex medical histories. Comparative Analysis with Existing Literature Our observed complication rates and mortality patterns demonstrate both similarities and notable differences compared to published studies in amputation surgery. The 19% readmission rate following outpatient procedures reported by Casciato et al. in geriatric transmetatarsal amputation patients closely parallels our 13.6% unplanned readmission rate, though their focus on functional dependence as a primary predictor differs from our emphasis on composite frailty scoring [ 14 ]. Sareh et al. identified 15.2% frailty prevalence in 302,798 patients undergoing minor lower extremity amputation, substantially lower than our 7.1% severely frail classification, likely reflecting differences in demographic characteristics and amputation complexity [ 15 ]. The racial disparities identified by Pandit et al., showing increased frailty risk among African American and Hispanic patients, could not be fully explored in our predominantly White cohort, highlighting the need for more diverse study populations to address health equity concerns in amputation surgery [ 16 ]. Clinical Relevance and Implementation The CARP score provides clinicians with a practical, easily calculated risk assessment tool that incorporates readily available clinical variables to stratify patients across multiple outcome domains. Unlike complex frailty assessments requiring specialized testing, our composite score utilizes standard preoperative data including ASA classification, RAI components, and PACS variables to generate individualized risk estimates. This approach enables targeted perioperative interventions, such as enhanced preoperative optimization for high-risk patients, modified surgical approaches for severely frail individuals, and informed discussions regarding realistic expectations for functional recovery and long-term outcomes. The score's superior discriminative ability for major complications and mortality supports its potential integration into clinical decision-making algorithms, quality improvement initiatives, and resource allocation strategies. Healthcare systems can utilize CARP scoring to identify patients requiring multidisciplinary care coordination, specialized rehabilitation services, and prolonged post-acute care planning. Study Limitations Several limitations must be acknowledged in interpreting our findings. The retrospective design utilizing ACS-NSQIP data inherently limits the granularity of clinical information available, potentially missing important frailty indicators such as cognitive function, social support systems, and functional performance measures that may influence outcomes. The exclusively male diabetic population, while providing homogeneity for analysis, limits generalizability to female patients and non-diabetic individuals undergoing upper extremity amputation. Database limitations precluded assessment of important long-term outcomes including functional recovery, prosthetic use, quality of life measures, and survival beyond 30 days, which represent critical endpoints for amputation patients. The relatively low event rates for some complications, particularly minor complications (0.48%), may have limited statistical power for detecting significant associations. Additionally, unmeasured confounders such as social determinants of health, healthcare access barriers, and institution-specific practice variations could influence the observed relationships between frailty indices and outcomes. Future Research Directions Prospective validation studies are essential to confirm the CARP score's predictive accuracy and clinical utility across diverse populations and healthcare settings. Future investigations should incorporate comprehensive frailty assessments including cognitive testing, physical performance measures, and patient-reported outcome measures to enhance risk prediction accuracy. Long-term follow-up studies examining functional outcomes, prosthetic utilization, quality of life, and survival patterns are crucial for understanding the full impact of frailty on amputation recovery trajectories. Research addressing health disparities in amputation outcomes, particularly among underserved populations with limited access to specialized care, represents a critical area for investigation. Development of risk prediction models incorporating machine learning techniques and integration of novel biomarkers may further improve prognostic accuracy. Implementation science studies evaluating the effectiveness of CARP score-guided interventions on clinical outcomes, resource utilization, and healthcare costs will be essential for widespread adoption in clinical practice. CONCLUSION The novel CARP score demonstrates superior predictive accuracy compared to individual frailty indices for major complications and mortality in diabetic male patients undergoing upper extremity amputation, providing clinicians with a practical risk stratification tool for perioperative decision-making. This composite scoring system addresses a critical gap in amputation surgery risk assessment and warrants prospective validation to establish its clinical utility across diverse patient populations. Declarations Author Contribution C.S. and B.J. conceived the project and supervised all aspects of the study. A.A. performed literature review, formatted the manuscript, organized references using Zotero, submitted the abstract to AAOS, and led the final preparation of submission materials and final oversight of figures and tables. C.S. conducted the data analysis and generated the figures. B.J. and J.F. provided clinical oversight and critical revisions. All authors contributed to manuscript drafting and revision, and approved the final version of the manuscript. Data Availability Data Availability: All data supporting the findings of this study are included in the manuscript and supplementary materials. Additional anonymized data may be made available by the corresponding author upon reasonable request. References Gonzalez M, Paz M, Babrowski T (2025) Association of Frailty Index and Postoperative Outcomes of Open Bypass Lower Extremity Revascularization for Acute Limb Ischemia Using the Vascular Quality Initiative. Vasc Endovascular Surg 59:387–395. https://doi.org/10.1177/15385744241301178 Desai A, Luo A, Borowsky PA, et al (2024) Evaluation of Modified Frailty Index for Predicting Postoperative Outcomes after Upper Extremity Replantation and Revascularization Procedures. 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Ann Vasc Surg 86:295–304. https://doi.org/10.1016/j.avsg.2022.04.007 Pandit V, Tan T-W, Kempe K, et al (2021) Frailty Syndrome in Patients With Lower Extremity Amputation: Simplifying How We Calculate Frailty. J Surg Res 263:230–235. https://doi.org/10.1016/j.jss.2020.12.038 Casciato DJ, Kirkham K, Wynes J (2024) 30-Day Readmission Following Outpatient Transmetatarsal Amputation in the Geriatric Population: An ACS NSQIP Analysis. J Foot Ankle Surg 63:55–58. https://doi.org/10.1053/j.jfas.2023.08.013 Sareh S, Ugarte R, Dobaria V, et al (2020) Impact of Frailty on Clinical and Financial Outcomes Following Minor Lower Extremity Amputation: A Nationwide Analysis. Am Surg 86:1312–1317. https://doi.org/10.1177/0003134820964230 Pandit V, Nelson P, Kempe K, et al (2020) Racial and ethnic disparities in lower extremity amputation: Assessing the role of frailty in older adults. Surgery 168:1075–1078. https://doi.org/10.1016/j.surg.2020.07.015 Tables Table 1. The association of patient demographics and comorbidities and Risk Analysis Index (RAI) tiers. COPD, Chronic Obstructive Pulmonary Disease; CHF, Congestive Heart Failure; mFI-5, Modified Frailty Index-5; RAI, Risk Analysis Index; GNRI, Geriatric Nutritional Risk Index. Variable Total (n=829) Not frail (RAI ≤ 20) (n=522) Prefrail (RAI = 21–30) (n=248) Frail (RAI = 31–40) (n=54) Severely frail (RAI ≥ 41) (n=5) p-value Age (yr) 58.8 ± 11.4 53.6 ± 9.0 67.8 ± 9.2 66.8 ± 9.3 71.6 ± 12.9 <0.001 Sex, male 829 (100.0) 522 (100.0) 248 (100.0) 54 (100.0) 5 (100.0) - Race 0.155 White 607 (73.2) 383 (73.4) 187 (75.4) 32 (59.3) 5 (100.0) Black or African American 161 (19.4) 98 (18.8) 46 (18.5) 17 (31.5) 0 (0.0) AAPI 43 (5.2) 28 (5.4) 13 (5.2) 2 (3.7) 0 (0.0) American Indian/Alaska Native 18 (2.2) 13 (2.5) 2 (0.8) 3 (5.6) 0 (0.0) Body mass index (kg/m²) 31.3 ± 8.7 31.5 ± 8.6 31.5 ± 8.6 28.7 ± 9.7 32.0 ± 11.6 0.011 Functional status <0.001 Independent 678 (84.0) 501 (98.2) 170 (71.1) 7 (13.2) 0 (0.0) Partially dependent 104 (12.9) 9 (1.8) 66 (27.6) 28 (52.8) 1 (20.0) Totally dependent 25 (3.1) 0 (0.0) 3 (1.3) 18 (34.0) 4 (80.0) Diabetes mellitus 0.165 Insulin 598 (72.1) 371 (71.1) 177 (71.4) 46 (85.2) 4 (80.0) Oral medication 231 (27.9) 151 (28.9) 71 (28.6) 8 (14.8) 1 (20.0) COPD 67 (8.1) 22 (4.2) 33 (13.3) 10 (18.5) 2 (40.0) <0.001 CHF 53 (6.4) 6 (1.2) 24 (9.7) 19 (35.2) 4 (80.0) <0.001 Current smoker 210 (25.3) 147 (28.2) 55 (22.2) 8 (14.8) 0 (0.0) 0.039 Dyspnea at rest 78 (9.4) 17 (3.3) 47 (19.0) 13 (24.1) 1 (20.0) <0.001 Hypertension 635 (76.6) 375 (71.8) 208 (83.9) 48 (88.9) 4 (80.0) <0.001 Disseminated cancer 2 (0.2) 0 (0.0) 1 (0.4) 1 (1.9) 0 (0.0) 0.061 Steroid use 52 (6.3) 21 (4.0) 24 (9.7) 6 (11.1) 1 (20.0) 0.004 Weight loss 17 (2.1) 7 (1.3) 8 (3.2) 2 (3.7) 0 (0.0) 0.278 mFI-5 <0.001 Not frail (mFI-5 = 0) 54 (6.5) 46 (8.8) 8 (3.2) 0 (0.0) 0 (0.0) Prefrail (mFI-5 = 1) 243 (29.3) 188 (36.0) 55 (22.2) 0 (0.0) 0 (0.0) Frail (mFI-5 = 2) 367 (44.3) 254 (48.7) 99 (39.9) 13 (24.1) 1 (20.0) Severely frail (mFI-5 ≥ 3) 165 (19.9) 34 (6.5) 86 (34.7) 41 (75.9) 4 (80.0) GNRI 0.001 >98 413 (49.8) 270 (51.7) 121 (48.8) 20 (37.0) 2 (40.0) 92–98 133 (16.0) 78 (14.9) 50 (20.2) 4 (7.4) 1 (20.0) 82-91 149 (18.0) 99 (19.0) 40 (16.1) 10 (18.5) 0 (0.0) <82 134 (16.2) 75 (14.4) 37 (14.9) 20 (37.0) 2 (40.0) ASA <0.001 I 4 (0.5) 4 (0.8) 0 (0.0) 0 (0.0) 0 (0.0) II 79 (9.5) 68 (13.0) 11 (4.4) 0 (0.0) 0 (0.0) III 480 (57.9) 322 (61.7) 134 (54.0) 23 (42.6) 1 (20.0) IV 266 (32.1) 128 (24.5) 103 (41.5) 31 (57.4) 4 (80.0) Length of stay after operation (day) 4.1 ± 6.7 3.7 ± 6.3 4.4 ± 7.1 5.9 ± 8.3 12.0 ± 10.4 0.010 Operative time (min) 41.5 ± 33.6 40.1 ± 34.0 41.9 ± 31.8 47.6 ± 32.3 93.4 ± 45.3 0.010 Note : Data are presented as n (%) or mean ± standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (>75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis. Table 2. 30-day outcome measures including mortality, nonroutine discharge, extended Length of Stay (eLOS), occurrence of complication, major complications, reoperation, and readmission among Risk Analysis Index (RAI) tiers. Variable Total (n=829) Not frail (RAI ≤ 20) (n=522) Prefrail (RAI = 21–30) (n=248) Frail (RAI = 31–40) (n=54) Severely frail (RAI ≥ 41) (n=5) P value Mortality 18 (2.2) 5 (1.0) 4 (1.6) 7 (13.0) 2 (40.0) <0.001 Nonroutine discharge destination 104 (12.6) 34 (6.5) 39 (16.0) 14 (26.4) 4 (80.0) <0.001 eLOS 192 (23.2) 105 (20.1) 65 (26.2) 19 (35.2) 3 (60.0) 0.007 Any complication 96 (11.6) 57 (10.9) 35 (14.1) 4 (7.4) 0 (0.0) 0.287 Major complications 92 (11.1) 52 (10.0) 35 (14.1) 5 (9.3) 0 (0.0) 0.287 Readmission 113 (13.6) 64 (12.3) 38 (15.3) 10 (18.5) 1 (20.0) 0.440 Reoperation 84 (10.1) 46 (8.8) 30 (12.1) 7 (13.0) 1 (20.0) 0.383 Note : Data are presented as n (%) or mean ± standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (>75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis. Table 3. 30-day outcome measures including mortality, nonroutine discharge, extended Length of Stay (eLOS), occurrence of complication, major complications, reoperation, and readmission among Geriatric Nutritional Risk Index (GNRI) tiers. Variable Total (n=829) GNRI >98 (n=413) GNRI =92–98 (n=133) GNRI =82-91 (n=149) GNRI <82 (n=134) P value Mortality 18 (2.2) 3 (0.7) 3 (2.3) 6 (4.0) 6 (4.5) 0.020 Nonroutine discharge destination 91 (11.1) 22 (5.4) 10 (7.6) 24 (16.2) 35 (26.5) <0.001 eLOS 192 (23.2) 52 (12.6) 27 (20.3) 55 (36.9) 58 (43.3) <0.001 Any complication 96 (11.6) 23 (5.6) 15 (11.3) 32 (21.5) 26 (19.4) <0.001 Major complications 92 (11.1) 19 (4.6) 15 (11.3) 32 (21.5) 26 (19.4) <0.001 Readmission 113 (13.6) 40 (9.7) 18 (13.5) 24 (16.1) 31 (23.1) 0.001 Reoperation 84 (10.1) 27 (6.5) 12 (9.0) 22 (14.8) 23 (17.2) 0.001 Note : Data are presented as n (%) or mean ± standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (>75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis. Table 4. Univariate logistic regression analysis of GNRI and RAI and major postoperative measures in surgery patients. GNRI; Geriatric Nutritional Risk Index, RAI; Risk Analysis Index. Patient groups with GNRI > 98 and RAI ≤ 20 were the reference for GNRI and RAI regression analyses, respectively. Outcome GNRI category Odds ratio (95% confidence interval) RAI category Odds ratio (95% confidence interval) Mortality 92–98 3.18 (0.65-15.58) 21–30 1.64 (0.46-5.89) 82-91 5.67 (1.45-22.13) 31–40 15.38 (5.36-44.12) <82 6.44 (1.65-25.19) ≥ 41 61.67 (9.07-419.5) Nonroutine discharge destination 92–98 1.45 (0.68-3.12) 21–30 2.72 (1.69-4.38) 82-91 3.34 (1.89-5.89) 31–40 5.14 (2.64-10.01) <82 6.27 (3.66-10.74) ≥ 41 54.00 (5.75-506.7) eLOS 92–98 1.77 (1.07-2.94) 21–30 1.40 (1.00-1.96) 82-91 4.15 (2.73-6.31) 31–40 2.18 (1.22-3.89) <82 5.20 (3.39-7.96) ≥ 41 6.00 (1.07-33.58) Any complication 92–98 2.13 (1.17-3.87) 21–30 1.34 (0.86-2.10) 82-91 4.59 (2.74-7.70) 31–40 0.66 (0.23-1.88) <82 4.05 (2.38-6.88) ≥ 41 - Major complications 92–98 2.61 (1.33-5.12) 21–30 1.47 (0.92-2.36) 82-91 5.58 (3.24-9.61) 31–40 0.92 (0.35-2.44) <82 4.92 (2.81-8.60) ≥ 41 - Readmission 92–98 1.45 (0.81-2.58) 21–30 1.29 (0.83-2.00) 82-91 1.79 (1.07-2.99) 31–40 1.61 (0.77-3.36) <82 2.80 (1.75-4.49) ≥ 41 1.78 (0.21-15.13) Reoperation 92–98 1.42 (0.72-2.80) 21–30 1.42 (0.88-2.30) 82-91 2.47 (1.41-4.33) 31–40 1.54 (0.66-3.60) <82 2.93 (1.69-5.08) ≥ 41 2.54 (0.30-21.70) Note : Data are presented as n (%) or mean ± standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (>75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis. Table 5. Multivariable regression analysis of major complications and American Society of Anesthesiologists physical status class risk stratification system (ASA), Geriatric Nutritional Risk Index (GNRI), Risk Analysis Index (RAI), and Preoperative Acute Severe Condition (PACS). Variable Adjusted odds ratio 95% Confidence Interval - Lower Bound 95% Confidence Interval - Upper Bound p-value ASA 1.71 1.11 2.64 0.015 PACS 2.74 2.03 3.69 <0.001 GNRI 0.96 0.94 0.99 0.003 RAI 0.96 0.93 1.00 0.049 Note : Data are presented as n (%) or mean ± standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (>75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis. Table 6. AUC with 95% confidence interval for the American Society of Anesthesiologists (ASA) physical status class risk stratification system (ASA), Geriatric Nutritional Risk Index (GNRI), Risk Analysis Index (RAI), and Combined GNRI-ASA-RAI-PACS (CARP) and post-operative outcomes. The DeLong test was used to compare all indices against the novel compound score. AUC; Area Under the receiver operating characteristic Curve. Outcome Variable Index AUC 95% Confidence Interval p-value Lower Upper Major complications CARP 0.748 0.687 0.795 RAI 0.550 0.481 0.608 ASA 0.625 0.566 0.671 GNRI 0.726 0.667 0.770 mFI-5 0.588 0.521 0.644 Minor complications CARP 0.819 0.680 0.942 RAI 0.631 0.375 0.874 ASA 0.502 0.394 0.601 GNRI 0.843 0.711 0.958 mFI-5 0.604 0.340 0.855 Nonroutine discharge destination CARP 0.613 0.550 0.678 RAI 0.686 0.620 0.752 ASA 0.625 0.566 0.671 GNRI 0.639 0.576 0.702 mFI-5 0.634 0.570 0.698 eLOS CARP 0.643 0.589 0.685 RAI 0.562 0.504 0.609 ASA 0.574 0.528 0.608 GNRI 0.631 0.576 0.672 mFI-5 0.583 0.533 0.621 Readmission CARP 0.620 0.550 0.678 RAI 0.516 0.466 0.555 ASA 0.599 0.544 0.643 GNRI 0.582 0.519 0.633 mFI-5 0.557 0.503 0.599 Reoperation CARP 0.593 0.512 0.662 RAI 0.547 0.479 0.603 ASA 0.593 0.531 0.644 GNRI 0.583 0.512 0.642 mFI-5 0.589 0.515 0.650 Note : Data are presented as n (%) or mean ± standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (>75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis. Table 7. Internal validation of Area Under the Receiver operating Curve analysis of American Society of Anesthesiologists physical status class risk stratification system (ASA), Geriatric Nutritional Risk Index (GNRI), Risk Analysis Index (RAI), and Combined GNRI-ASA-RAI-PACS (CARP) by bootstrapping replications. Outcome Variable Index Initial AUC Internal Validation AUC Bias-Corrected Confidence Intervals Lower bound Major complications CARP 0.748 0.741 0.687 RAI 0.550 0.544 0.481 ASA 0.625 0.619 0.566 GNRI 0.726 0.719 0.667 mFI-5 0.588 0.583 0.521 Minor complications CARP 0.819 0.811 0.680 RAI 0.631 0.624 0.375 ASA 0.502 0.497 0.394 GNRI 0.843 0.835 0.711 mFI-5 0.604 0.597 0.340 Nonroutine discharge destination CARP 0.620 0.614 0.550 RAI 0.516 0.511 0.466 ASA 0.599 0.593 0.544 GNRI 0.582 0.576 0.519 mFI-5 0.557 0.551 0.503 eLOS CARP 0.643 0.637 0.589 RAI 0.562 0.557 0.504 ASA 0.574 0.568 0.528 GNRI 0.631 0.624 0.576 mFI-5 0.583 0.577 0.533 Readmission CARP 0.620 0.614 0.550 RAI 0.516 0.511 0.466 ASA 0.599 0.593 0.544 GNRI 0.582 0.576 0.519 mFI-5 0.557 0.551 0.503 Reoperation CARP 0.593 0.587 0.512 RAI 0.547 0.541 0.479 ASA 0.593 0.587 0.531 GNRI 0.583 0.577 0.512 mFI-5 0.589 0.583 0.515 Note : Data are presented as n (%) or mean ± standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (>75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6781675","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":465347124,"identity":"50eec773-6971-4fb9-97da-62757df9984c","order_by":0,"name":"Cameron Sabet","email":"","orcid":"","institution":"Georgetown University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Cameron","middleName":"","lastName":"Sabet","suffix":""},{"id":465347125,"identity":"7cdb95ba-ed14-4867-baa8-f1d8cb24c1fb","order_by":1,"name":"Bhav Jain","email":"","orcid":"","institution":"Stanford Medicine","correspondingAuthor":false,"prefix":"","firstName":"Bhav","middleName":"","lastName":"Jain","suffix":""},{"id":465347126,"identity":"a1eae437-e3bc-4079-809f-96a7fdb6fe29","order_by":2,"name":"Arnav Ajay Jadav","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYJACAwYGNgaGAwyMD0A8PiCWIFYLswFINRsxWiDgAAObBFFa+BuYHxT8bOOT5zt+xqyat62ujo2B+eBtHjxaJA6wGRj2trEZzjyTY3abt+0w0Ba2ZGt8WoDuMTDgbWNj3HAgLe12btsBoBYeM2l8WuQPsH8w/NvGZr/h/LO04ty2OqAW/m94tRgc4DEwBtqSuOFG8jHm3DZmkC1seLUYHuYpMJY5x5Y888bjw9J/zh2WbGNmM7acg0eL3PH2bYZvyo7Z9p1PbPw4o6yOn5+9+eGNN/i8z8zAZsDIdgxFhCBgfsDwp4awslEwCkbBKBi5AABj4UbXTfjazAAAAABJRU5ErkJggg==","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":true,"prefix":"","firstName":"Arnav","middleName":"Ajay","lastName":"Jadav","suffix":""},{"id":465347127,"identity":"ad12228b-5722-491f-a868-261dab7813eb","order_by":3,"name":"Jonathan Franco","email":"","orcid":"","institution":"Brigham and Women's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jonathan","middleName":"","lastName":"Franco","suffix":""}],"badges":[],"createdAt":"2025-05-30 06:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6781675/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6781675/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83903976,"identity":"582bac0b-a327-4c37-8dae-5e650a9259a9","added_by":"auto","created_at":"2025-06-04 09:54:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":655431,"visible":true,"origin":"","legend":"\u003cp\u003eA: 30-day major complications for adult male patients with insulin- and non-insulin dependent diabetes analyzing the modified frailty index-5 (mFI-5), Risk Analysis Index (RAI), Geriatric Nutritional Risk Index (GNRI), Preoperative Acute Severe Condition (PACS), Combined ASA-RAI-PACS (CARP), and American Society of Anesthesiology (ASA) scores.\u003c/p\u003e\n\u003cp\u003eB: 30-day minor complications for adult male patients with insulin- and non-insulin dependent diabetes analyzing the modified frailty index-5 (mFI-5), Risk Analysis Index (RAI), Geriatric Nutritional Risk Index (GNRI), Preoperative Acute Severe Condition (PACS), Combined ASA-RAI-PACS (CARP), and American Society of Anesthesiology (ASA) scores.\u003c/p\u003e\n\u003cp\u003eC: 30-day unplanned readmission for adult male patients with insulin- and non-insulin dependent diabetes analyzing the modified frailty index-5 (mFI-5), Risk Analysis Index (RAI), Geriatric Nutritional Risk Index (GNRI), Preoperative Acute Severe Condition (PACS), Combined ASA-RAI-PACS (CARP), and American Society of Anesthesiology (ASA) scores.\u003c/p\u003e\n\u003cp\u003eD: 30-day unplanned reoperations for adult male patients with insulin- and non-insulin dependent diabetes analyzing the modified frailty index-5 (mFI-5), Risk Analysis Index (RAI), Geriatric Nutritional Risk Index (GNRI), Preoperative Acute Severe Condition (PACS), Combined ASA-RAI-PACS (CARP), and American Society of Anesthesiology (ASA) scores.\u003c/p\u003e\n\u003cp\u003eE: 30-day extended length of stay for adult male patients with insulin- and non-insulin dependent diabetes analyzing the modified frailty index-5 (mFI-5), Risk Analysis Index (RAI), Geriatric Nutritional Risk Index (GNRI), Preoperative Acute Severe Condition (PACS), Combined ASA-RAI-PACS (CARP), and American Society of Anesthesiology (ASA) scores.\u003c/p\u003e\n\u003cp\u003eF: 30-day non-home discharge destination for adult male patients with insulin- and non-insulin dependent diabetes analyzing the modified frailty index-5 (mFI-5), Risk Analysis Index (RAI), Geriatric Nutritional Risk Index (GNRI), Preoperative Acute Severe Condition (PACS), Combined ASA-RAI-PACS (CARP), and American Society of Anesthesiology (ASA) scores.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6781675/v1/11e0bfb3dca70ca9f057139c.png"},{"id":95797611,"identity":"e202bbc1-10df-4df0-9b39-a2167b4d5cfe","added_by":"auto","created_at":"2025-11-13 08:07:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2946413,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6781675/v1/7af7f8e6-b360-4c37-9966-ffbcc56d7b25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Redefining Risk Assessment for Upper Extremity Amputation in Male Diabetic Patients: A National Analysis of Outcomes Using ACS-NSQIP Data (2015–2021)","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eUpper extremity amputations represent a significant surgical burden in the United States, with diabetic patients comprising a substantial proportion of cases requiring these procedures due to complications of peripheral vascular disease and infection. The aging population and increasing prevalence of diabetes mellitus have contributed to rising surgical volumes, with these procedures carrying substantial morbidity and mortality risks that disproportionately affect older patients with multiple comorbidities. Effective preoperative risk stratification has become increasingly crucial for optimizing surgical outcomes, guiding shared decision-making between patients and surgeons, and improving resource allocation in healthcare systems. The complexity of managing diabetic patients undergoing upper extremity amputation necessitates comprehensive assessment tools that can accurately predict postoperative complications and guide perioperative care strategies.\u003c/p\u003e \u003cp\u003eCurrent risk stratification tools in surgical practice include individual measures such as the Risk Analysis Index (RAI), which has demonstrated predictive validity for mortality and discharge disposition in vascular surgery patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and frailty indices like the modified 5-item frailty index (mFI-5), which has shown effectiveness in predicting complications across various surgical specialties including upper extremity procedures [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The Geriatric Nutritional Risk Index (GNRI) provides additional nutritional assessment capabilities that complement frailty measures in surgical risk prediction. However, despite extensive research demonstrating the individual utility of these tools across orthopedic surgery [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], plastic surgery [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and vascular procedures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], significant limitations persist in their application to upper extremity amputation patients. Studies have shown that while individual frailty measures can predict specific outcomes such as functional independence loss [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and reoperation rates [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], no comprehensive composite scoring system has been validated specifically for this high-risk population.\u003c/p\u003e \u003cp\u003eA critical gap exists in the current literature regarding the combined analysis of multiple validated risk indices for predicting adverse outcomes following upper extremity amputation in diabetic patients. While previous investigations have examined individual risk factors in isolation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], there remains an unmet need for a comprehensive composite risk stratification tool that integrates frailty, nutritional status, and acute severity measures to provide superior predictive accuracy. Therefore, this study aims to develop and validate the Combined ASA-RAI-Preoperative Acute Severe Condition (CARP) score, a novel composite risk assessment tool, and compare its predictive performance against established individual risk indices for postoperative outcomes in male diabetic patients undergoing upper extremity amputation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Source and Patient Consent\u003c/h2\u003e \u003cp\u003ePatient data was extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database covering the period from 2015 to 2021. The ACS NSQIP is a validated, multi-institutional registry that encompasses over 700 hospitals and captures more than 200 variables related to preoperative risk factors, intraoperative variables, and 30-day postoperative outcomes. This study was conducted in compliance with HIPAA regulations and was exempt from institutional review board approval due to the retrospective nature of the deidentified data. Informed consent was waived given the retrospective design and use of publicly available deidentified data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatient Selection\u003c/h3\u003e\n\u003cp\u003eAdult male diabetic patients aged 18 years or older who underwent upper extremity amputation procedures were identified using Current Procedural Terminology codes 25900, 25905, 25920, 25927, 26910, 26951, and 26952. Exclusion criteria included patients aged 90 years or older (top-coded as 90), those with diagnoses of cancer or infection, missing data on critical outcomes including mortality, discharge destination, functional status, or transfer status, emergency procedures, and incomplete frailty-related variables. Additional exclusions were made for patients with missing operative time, ASA classification, elective surgery status, length of stay, sex, race, or age data. After applying all inclusion and exclusion criteria, the final analytic cohort comprised 829 patients.\u003c/p\u003e\n\u003ch3\u003eRisk Indices\u003c/h3\u003e\n\u003cp\u003eThe Risk Analysis Index (RAI) was calculated to assess frailty using age, sex, renal impairment, dyspnea, cancer status, weight loss, and functional status as key variables. Patients were categorized into frailty tiers as robust (RAI\u0026thinsp;\u0026le;\u0026thinsp;20), normal (RAI 21\u0026ndash;30), frail (RAI 31\u0026ndash;40), and very frail (RAI\u0026thinsp;\u0026ge;\u0026thinsp;41). The Geriatric Nutritional Risk Index (GNRI) was calculated as GNRI = (1.489 \u0026times; serum albumin [g/L]) + (41.7 \u0026times; [weight/ideal body weight]), where ideal body weight was determined using the Devine formula with weight ratios capped at 1.0 for overweight patients. GNRI categories included normal (\u0026ge;\u0026thinsp;98), mild malnutrition (92-97.9), moderate malnutrition (82-91.9), and severe malnutrition (\u0026lt;\u0026thinsp;82). The American Society of Anesthesiologists classification (I-no disturbance, II-mild systemic disease, III-severe systemic disease, IV-life-threatening disease) was used for preoperative risk stratification. The Modified Frailty Index-5 incorporated functional dependence, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, and hypertension requiring medication. The Combined ASA-RAI-Preoperative Acute Severe Condition (CARP) score was derived from multivariable logistic regression using weighted coefficients from each risk index with internal validation performed using 100 bootstrap replications.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation with distribution assessed using the Kolmogorov-Smirnov test. Categorical variables were compared using chi-square tests, while the Kruskal-Wallis test was used for non-normally distributed continuous variables across frailty quartiles. Multivariable logistic regression models were constructed to identify predictors of adverse outcomes using adjusted odds ratios and 95% confidence intervals. Receiver operating characteristic curve analysis assessed model discrimination with C-statistics, and the DeLong test compared predictive performances between models. Internal validation employed 100 bootstrap replications with replacement to evaluate the stability and robustness of the CARP score. All statistical analyses were performed using Stata MP Version 18 in the Redivis computing environment with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatient Characteristics\u003c/h2\u003e \u003cp\u003eA total of 1,214 patients were initially identified from the ACS-NSQIP database, with 385 patients excluded due to missing frailty-related variables (n\u0026thinsp;=\u0026thinsp;156), cancer or infection diagnoses (n\u0026thinsp;=\u0026thinsp;130), age\u0026thinsp;\u0026ge;\u0026thinsp;90 years (n\u0026thinsp;=\u0026thinsp;8), emergency procedures (n\u0026thinsp;=\u0026thinsp;26), and other missing essential data (n\u0026thinsp;=\u0026thinsp;65), resulting in a final analytic cohort of 829 patients. The cohort was entirely male (n\u0026thinsp;=\u0026thinsp;829, 100%) with a mean age of 58.84 years (SD 11.36). The racial distribution included 607 White patients (73.22%), 161 Black or African American patients (19.42%), 43 Asian/Pacific Islander patients (5.19%), and 18 American Indian or Alaska Native patients (2.17%). Mean body mass index was 31.33 kg/m\u0026sup2; (SD 8.69), mean total hospital length of stay was 4.14 days (SD 6.75), and mean operative time was 41.49 minutes (SD 33.56).\u003c/p\u003e \u003cp\u003eRegarding functional status, 678 patients (84.01%) were functionally independent, 104 patients (12.89%) were partially dependent, and 25 patients (3.10%) were totally dependent. Diabetes mellitus was present in all patients by study design, with 598 patients (72.14%) having insulin-dependent diabetes and 231 patients (27.86%) having non-insulin-dependent diabetes. Additional comorbidities included hypertension requiring medication in 635 patients (76.60%), chronic obstructive pulmonary disease in 67 patients (8.08%), congestive heart failure in 53 patients (6.39%), bleeding disorders in 159 patients (19.18%), chronic steroid use in 52 patients (6.27%), dyspnea on moderate exertion or at rest in 78 patients (9.41%), current smoking in 210 patients (25.33%), renal impairment in 45 patients (5.43%), and recent weight loss in 17 patients (2.05%). ASA classification showed 4 patients (0.48%) as ASA I, 79 patients (9.53%) as ASA II, 480 patients (57.90%) as ASA III, and 266 patients (32.09%) as ASA IV.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eUnivariate Analysis and Risk Stratification\u003c/h3\u003e\n\u003cp\u003eModified Frailty Index-5 (mFI-5) scores ranged from 0 to 5, with tier distribution showing 54 patients (6.51%) as not frail, 243 patients (29.31%) as prefrail, 367 patients (44.27%) as frail, and 165 patients (19.90%) as severely frail. Risk Analysis Index (RAI) scores ranged from 4 to 46 points, with 522 patients (62.97%) classified as not frail (\u0026le;\u0026thinsp;20 points), 248 patients (29.92%) as prefrail (21\u0026ndash;30 points), 54 patients (6.51%) as frail (31\u0026ndash;40 points), and 5 patients (0.60%) as severely frail (\u0026ge;\u0026thinsp;41 points). Geriatric Nutritional Risk Index (GNRI) scores were available for 519 patients, with tier distribution showing 134 patients (16.16%) at major risk (\u0026lt;\u0026thinsp;82), 149 patients (17.97%) at moderate risk (82\u0026ndash;91), 133 patients (16.04%) at low risk (92\u0026ndash;98), and 413 patients (49.82%) at no risk (\u0026ge;\u0026thinsp;99). Preoperative Acute Severe Condition (PACS) scores were available for 784 patients with mean score of 0.54 (SD 0.74).\u003c/p\u003e \u003cp\u003eIn univariate analysis, mFI-5 score was significantly associated with major complications (OR 1.42, 95% CI 1.13\u0026ndash;1.78, p\u0026thinsp;=\u0026thinsp;0.003), extended length of stay (OR 1.37, 95% CI 1.15\u0026ndash;1.64, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), unplanned reoperation (OR 1.34, 95% CI 1.06\u0026ndash;1.70, p\u0026thinsp;=\u0026thinsp;0.015), and non-home discharge (OR 1.71, 95% CI 1.36\u0026ndash;2.14, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). RAI score demonstrated significant associations with extended length of stay (OR 1.04, 95% CI 1.02\u0026ndash;1.06, p\u0026thinsp;=\u0026thinsp;0.001) and non-home discharge (OR 1.10, 95% CI 1.07\u0026ndash;1.14, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). PACS score showed the strongest univariate associations with major complications (OR 2.69, 95% CI 2.06\u0026ndash;3.53, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), minor complications (OR 2.76, 95% CI 1.22\u0026ndash;6.24, p\u0026thinsp;=\u0026thinsp;0.015), unplanned readmission (OR 1.45, 95% CI 1.13\u0026ndash;1.87, p\u0026thinsp;=\u0026thinsp;0.004), unplanned reoperation (OR 1.38, 95% CI 1.05\u0026ndash;1.82, p\u0026thinsp;=\u0026thinsp;0.022), extended length of stay (OR 1.98, 95% CI 1.53\u0026ndash;2.57, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and non-home discharge (OR 1.94, 95% CI 1.46\u0026ndash;2.58, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). ASA classification was significantly associated with major complications (OR 2.37, 95% CI 1.61\u0026ndash;3.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), unplanned readmission (OR 1.94, 95% CI 1.33\u0026ndash;2.83, p\u0026thinsp;=\u0026thinsp;0.001), unplanned reoperation (OR 1.84, 95% CI 1.19\u0026ndash;2.84, p\u0026thinsp;=\u0026thinsp;0.006), extended length of stay (OR 1.65, 95% CI 1.23\u0026ndash;2.21, p\u0026thinsp;=\u0026thinsp;0.001), and non-home discharge (OR 2.37, 95% CI 1.61\u0026ndash;3.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003ch3\u003eMultivariable Analysis\u003c/h3\u003e\n\u003cp\u003eAfter adjustment for all frailty indices in multivariable models, PACS score remained the most robust predictor across multiple outcomes. For major complications, PACS score (OR 2.74, 95% CI 2.01\u0026ndash;3.73, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), GNRI score (OR 0.96, 95% CI 0.94\u0026ndash;0.99, p\u0026thinsp;=\u0026thinsp;0.003), and RAI score (OR 0.94, 95% CI 0.89\u0026ndash;0.99, p\u0026thinsp;=\u0026thinsp;0.010) were independently significant, while mFI-5 score (OR 1.04, 95% CI 0.76\u0026ndash;1.41, p\u0026thinsp;=\u0026thinsp;0.823) and ASA classification (OR 1.65, 95% CI 1.07\u0026ndash;2.55, p\u0026thinsp;=\u0026thinsp;0.025) were not independently predictive. For unplanned readmission, RAI score (OR 0.95, 95% CI 0.91-1.00, p\u0026thinsp;=\u0026thinsp;0.030) and ASA classification (OR 1.80, 95% CI 1.12\u0026ndash;2.89, p\u0026thinsp;=\u0026thinsp;0.015) remained significant predictors. For unplanned reoperation, only GNRI score (OR 0.97, 95% CI 0.94-1.00, p\u0026thinsp;=\u0026thinsp;0.028) maintained independent significance. For extended length of stay, PACS score (OR 1.66, 95% CI 1.26\u0026ndash;2.20, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and GNRI score (OR 0.95, 95% CI 0.93\u0026ndash;0.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were independently predictive. For non-home discharge, RAI score (OR 1.06, 95% CI 1.02\u0026ndash;1.12, p\u0026thinsp;=\u0026thinsp;0.009), PACS score (OR 1.47, 95% CI 1.05\u0026ndash;2.06, p\u0026thinsp;=\u0026thinsp;0.027), and GNRI score (OR 0.94, 95% CI 0.91\u0026ndash;0.96, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) remained independently significant.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMajor Postoperative Outcomes and Risk Stratification\u003c/h2\u003e \u003cp\u003eOverall 30-day mortality was 2.17% (n\u0026thinsp;=\u0026thinsp;18). Major complications occurred in 92 patients (11.10%), with rates varying significantly by GNRI tier: major risk 19.4%, moderate risk 21.5%, low risk 11.3%, and no risk 4.6% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Minor complications occurred in 4 patients (0.48%), with rates by GNRI tier of 2.2%, 0%, 0%, and 0.2% respectively (p\u0026thinsp;=\u0026thinsp;0.015). Unplanned readmission occurred in 113 patients (13.63%) with GNRI tier rates of 23.1%, 16.1%, 13.5%, and 9.7% respectively (p\u0026thinsp;=\u0026thinsp;0.001). Unplanned reoperation occurred in 84 patients (10.13%) with GNRI tier rates of 17.2%, 14.8%, 9.0%, and 6.5% respectively (p\u0026thinsp;=\u0026thinsp;0.001). Extended length of stay (\u0026gt;\u0026thinsp;75th percentile of 6 days) occurred in 192 patients (23.16%) with GNRI tier rates of 43.3%, 36.9%, 20.3%, and 12.6% respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Non-home discharge occurred in 91 patients (11.08%) with GNRI tier rates of 26.5%, 16.2%, 7.6%, and 5.4% respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eWhen stratified by RAI tier, mortality rates were 1.0% for not frail, 1.6% for prefrail, 13.0% for frail, and 40.0% for severely frail patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Major complication rates by RAI tier were 10.0%, 14.1%, 9.3%, and 0% respectively (p\u0026thinsp;=\u0026thinsp;0.287). Extended length of stay rates were 20.1%, 26.2%, 35.2%, and 60.0% respectively (p\u0026thinsp;=\u0026thinsp;0.007). Non-home discharge rates were 6.5%, 16.0%, 26.4%, and 100% respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eNovel Combined ASA-RAI-Preoperative Acute Severe Condition (CARP) Score\u003c/h2\u003e \u003cp\u003eThe novel CARP score was derived from multivariable regression coefficients: CARP = (β_RAI \u0026times; RAI_score) + (β_PACS \u0026times; PACS_score) + (β_ASA \u0026times; ASA_category), where β_RAI = -0.038, β_PACS\u0026thinsp;=\u0026thinsp;1.006, and β_ASA\u0026thinsp;=\u0026thinsp;0.536. This composite score demonstrated superior discriminative ability compared to individual indices for most outcomes. The CARP score achieved area under the receiver operating characteristic curve (AUROC) values of 0.748 (95% CI 0.687\u0026ndash;0.795) for major complications, 0.819 (95% CI 0.680\u0026ndash;0.942) for minor complications, 0.620 (95% CI 0.550\u0026ndash;0.678) for unplanned readmission, 0.593 (95% CI 0.512\u0026ndash;0.662) for unplanned reoperation, 0.643 (95% CI 0.589\u0026ndash;0.685) for extended length of stay, and 0.613 (95% CI 0.549\u0026ndash;0.674) for non-home discharge.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMain Results and Performance Comparison\u003c/h2\u003e \u003cp\u003eDirect comparison of AUROC values revealed PACS as the best individual predictor for major complications (AUROC 0.726, 95% CI 0.667\u0026ndash;0.770), significantly outperforming mFI-5 (AUROC 0.588, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), RAI (AUROC 0.550, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and ASA classification (AUROC 0.625, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) but not significantly different from CARP (p\u0026thinsp;=\u0026thinsp;0.403). For minor complications, PACS achieved the highest discrimination (AUROC 0.843, 95% CI 0.711\u0026ndash;0.958), not significantly different from CARP (p\u0026thinsp;=\u0026thinsp;0.715). RAI demonstrated superior performance for non-home discharge (AUROC 0.686, 95% CI 0.630\u0026ndash;0.740) compared to other individual indices. CARP consistently ranked among the top two predictors for all outcomes, demonstrating the value of the composite approach.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInternal Validation\u003c/h2\u003e \u003cp\u003eBootstrap validation with 100 replications was performed for all frailty indices across all outcomes. Bias-corrected AUROC values with 95% confidence intervals were: for major complications, mFI-5 0.583 (0.521\u0026ndash;0.644), RAI 0.544 (0.481\u0026ndash;0.608), PACS 0.719 (0.667\u0026ndash;0.770), CARP 0.741 (0.687\u0026ndash;0.795), and ASA 0.619 (0.566\u0026ndash;0.671). For extended length of stay, bias-corrected values were mFI-5 0.577 (0.533\u0026ndash;0.621), RAI 0.557 (0.504\u0026ndash;0.609), PACS 0.624 (0.576\u0026ndash;0.672), CARP 0.637 (0.589\u0026ndash;0.685), and ASA 0.568 (0.528\u0026ndash;0.608). For non-home discharge, bias-corrected values were mFI-5 0.583 (0.515\u0026ndash;0.650), RAI 0.541 (0.479\u0026ndash;0.603), PACS 0.577 (0.512\u0026ndash;0.642), CARP 0.587 (0.512\u0026ndash;0.662), and ASA 0.587 (0.531\u0026ndash;0.644). Optimism bias was minimal across all models, ranging from 0.005 to 0.008, indicating robust internal validity and minimal overfitting.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eWhy We Conducted This Study\u003c/h2\u003e \u003cp\u003eThe increasing prevalence of diabetes mellitus and its associated complications has led to a substantial rise in upper extremity amputations, particularly among vulnerable populations with multiple comorbidities. Frailty assessments have emerged as critical tools for preoperative risk stratification, with established utility in predicting adverse outcomes following major surgical procedures [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, existing frailty indices have primarily been validated in lower extremity amputation populations, with limited evidence regarding their predictive accuracy in upper extremity procedures. Furthermore, no composite scoring system has been developed to integrate multiple frailty domains with acute physiologic derangements for this specific population. The development of a novel Combined ASA-RAI-Preoperative Acute Severe Condition (CARP) score addresses this critical gap by providing a comprehensive risk assessment tool that incorporates frailty, functional status, and acute illness severity to optimize perioperative decision-making for diabetic male patients undergoing upper extremity amputation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSummary of Key Findings\u003c/h2\u003e \u003cp\u003eOur analysis of 829 diabetic male patients demonstrated that the novel CARP score consistently outperformed individual frailty indices in predicting major postoperative complications, achieving superior discriminative ability with an AUROC of 0.748 (95% CI 0.687\u0026ndash;0.795) compared to traditional indices. The PACS component emerged as the strongest individual predictor, with odds ratios exceeding 2.7 for major complications across both univariate and multivariable analyses. Risk stratification revealed striking disparities, with severely frail patients (RAI\u0026thinsp;\u0026ge;\u0026thinsp;41) experiencing 40% 30-day mortality compared to 1.0% in robust patients, while patients with major nutritional risk (GNRI\u0026thinsp;\u0026lt;\u0026thinsp;82) demonstrated 19.4% major complication rates versus 4.6% in those without nutritional risk. The composite CARP score maintained robust predictive accuracy across all outcomes after bootstrap validation, with minimal optimism bias ranging from 0.005 to 0.008, indicating excellent internal validity and reproducibility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLiterature Context and Validation\u003c/h2\u003e \u003cp\u003eOur findings align with extensive literature demonstrating the prognostic value of frailty assessments in amputation surgery, though most prior studies have focused on lower extremity procedures. Cotton et al. reported comparable mortality stratification using RAI scores in lower extremity amputation, with 1-year mortality rates of 8% for non-frail versus 43% for very frail patients, similar to our observed 30-day mortality patterns [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The simplified mFI-5 index validation by Pandit et al. in 8,681 geriatric patients undergoing lower limb amputation demonstrated strong predictive ability for mortality and complications, consistent with our findings showing significant associations between mFI-5 scores and multiple adverse outcomes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, our study extends these findings to upper extremity procedures in a predominantly middle-aged diabetic male population, representing a unique demographic with distinct risk profiles. The superior performance of PACS over traditional frailty indices in our cohort reflects the importance of acute physiologic derangements in determining surgical outcomes, particularly in diabetic patients with complex medical histories.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eComparative Analysis with Existing Literature\u003c/h2\u003e \u003cp\u003eOur observed complication rates and mortality patterns demonstrate both similarities and notable differences compared to published studies in amputation surgery. The 19% readmission rate following outpatient procedures reported by Casciato et al. in geriatric transmetatarsal amputation patients closely parallels our 13.6% unplanned readmission rate, though their focus on functional dependence as a primary predictor differs from our emphasis on composite frailty scoring [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Sareh et al. identified 15.2% frailty prevalence in 302,798 patients undergoing minor lower extremity amputation, substantially lower than our 7.1% severely frail classification, likely reflecting differences in demographic characteristics and amputation complexity [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The racial disparities identified by Pandit et al., showing increased frailty risk among African American and Hispanic patients, could not be fully explored in our predominantly White cohort, highlighting the need for more diverse study populations to address health equity concerns in amputation surgery [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eClinical Relevance and Implementation\u003c/h2\u003e \u003cp\u003eThe CARP score provides clinicians with a practical, easily calculated risk assessment tool that incorporates readily available clinical variables to stratify patients across multiple outcome domains. Unlike complex frailty assessments requiring specialized testing, our composite score utilizes standard preoperative data including ASA classification, RAI components, and PACS variables to generate individualized risk estimates. This approach enables targeted perioperative interventions, such as enhanced preoperative optimization for high-risk patients, modified surgical approaches for severely frail individuals, and informed discussions regarding realistic expectations for functional recovery and long-term outcomes. The score's superior discriminative ability for major complications and mortality supports its potential integration into clinical decision-making algorithms, quality improvement initiatives, and resource allocation strategies. Healthcare systems can utilize CARP scoring to identify patients requiring multidisciplinary care coordination, specialized rehabilitation services, and prolonged post-acute care planning.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eSeveral limitations must be acknowledged in interpreting our findings. The retrospective design utilizing ACS-NSQIP data inherently limits the granularity of clinical information available, potentially missing important frailty indicators such as cognitive function, social support systems, and functional performance measures that may influence outcomes. The exclusively male diabetic population, while providing homogeneity for analysis, limits generalizability to female patients and non-diabetic individuals undergoing upper extremity amputation. Database limitations precluded assessment of important long-term outcomes including functional recovery, prosthetic use, quality of life measures, and survival beyond 30 days, which represent critical endpoints for amputation patients. The relatively low event rates for some complications, particularly minor complications (0.48%), may have limited statistical power for detecting significant associations. Additionally, unmeasured confounders such as social determinants of health, healthcare access barriers, and institution-specific practice variations could influence the observed relationships between frailty indices and outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eFuture Research Directions\u003c/h2\u003e \u003cp\u003eProspective validation studies are essential to confirm the CARP score's predictive accuracy and clinical utility across diverse populations and healthcare settings. Future investigations should incorporate comprehensive frailty assessments including cognitive testing, physical performance measures, and patient-reported outcome measures to enhance risk prediction accuracy. Long-term follow-up studies examining functional outcomes, prosthetic utilization, quality of life, and survival patterns are crucial for understanding the full impact of frailty on amputation recovery trajectories. Research addressing health disparities in amputation outcomes, particularly among underserved populations with limited access to specialized care, represents a critical area for investigation. Development of risk prediction models incorporating machine learning techniques and integration of novel biomarkers may further improve prognostic accuracy. Implementation science studies evaluating the effectiveness of CARP score-guided interventions on clinical outcomes, resource utilization, and healthcare costs will be essential for widespread adoption in clinical practice.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe novel CARP score demonstrates superior predictive accuracy compared to individual frailty indices for major complications and mortality in diabetic male patients undergoing upper extremity amputation, providing clinicians with a practical risk stratification tool for perioperative decision-making. This composite scoring system addresses a critical gap in amputation surgery risk assessment and warrants prospective validation to establish its clinical utility across diverse patient populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor Contribution\u003c/p\u003e\n\u003cp\u003eC.S. and B.J. conceived the project and supervised all aspects of the study. A.A. performed literature review, formatted the manuscript, organized references using Zotero, submitted the abstract to AAOS, and led the final preparation of submission materials and final oversight of figures and tables. C.S. conducted the data analysis and generated the figures. B.J. and J.F. provided clinical oversight and critical revisions. All authors contributed to manuscript drafting and revision, and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eData Availability\u003c/p\u003e\n\u003cp\u003eData Availability: All data supporting the findings of this study are included in the manuscript and supplementary materials. Additional anonymized data may be made available by the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGonzalez M, Paz M, Babrowski T (2025) Association of Frailty Index and Postoperative Outcomes of Open Bypass Lower Extremity Revascularization for Acute Limb Ischemia Using the Vascular Quality Initiative. Vasc Endovascular Surg 59:387\u0026ndash;395. https://doi.org/10.1177/15385744241301178\u003c/li\u003e\n\u003cli\u003eDesai A, Luo A, Borowsky PA, et al (2024) Evaluation of Modified Frailty Index for Predicting Postoperative Outcomes after Upper Extremity Replantation and Revascularization Procedures. J Reconstr Microsurg a-2460-4706. https://doi.org/10.1055/a-2460-4706\u003c/li\u003e\n\u003cli\u003eAndersen JC, Gabel JA, Mannoia KA, et al (2020) 5-Item Modified Frailty Index Predicts Outcomes After Below-Knee Amputation in the Vascular Quality Initiative Amputation Registry. Am Surg 86:1225\u0026ndash;1229. https://doi.org/10.1177/0003134820964190\u003c/li\u003e\n\u003cli\u003eGonzalez M, Zietowski M, Patel R, et al (2025) Applying the Modified Five-Item Frailty Index to Predict Complications following Lower Extremity Free Flap Reconstruction in Trauma Patients. J Reconstr Microsurg a-2508-6716. https://doi.org/10.1055/a-2508-6716\u003c/li\u003e\n\u003cli\u003eGupta NK, Dunivin F, Chmait HR, et al (2025) Orthopedic frailty risk stratification (OFRS): a systematic review of the frailty indices predicting adverse outcomes in orthopedics. J Orthop Surg 20:247. https://doi.org/10.1186/s13018-025-05609-2\u003c/li\u003e\n\u003cli\u003ePanayi AC, Knoedler S, Didzun O, et al (2024) Loss of Functional Independence after Plastic Surgery in Older Patients: American College of Surgeons National Surgical Quality Improvement Program Database. Plast Reconstr Surg - Glob Open 12:e6167. https://doi.org/10.1097/GOX.0000000000006167\u003c/li\u003e\n\u003cli\u003eSarkar A, St. John A, Nagarsheth KH (2021) Predictive Effect of Frailty on Amputation, Mortality, and Ambulation in Patients Undergoing Revascularization for Acute Limb Ischemia. Ann Vasc Surg 73:273\u0026ndash;279. https://doi.org/10.1016/j.avsg.2020.10.048\u003c/li\u003e\n\u003cli\u003eChen S, Dunn R, Jackson M, et al (2023) Frailty score and outcomes of patients undergoing vascular surgery and amputation: A systematic review and meta-analysis. Front Cardiovasc Med 10:1065779. https://doi.org/10.3389/fcvm.2023.1065779\u003c/li\u003e\n\u003cli\u003eZhang D, Ostergaard PJ, Hall MJ, et al (2023) The Relationship Between Frailty and Functional Outcomes, Range of Motion, and Reoperation After Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture. Orthopedics 46:274\u0026ndash;279. https://doi.org/10.3928/01477447-20230330-02\u003c/li\u003e\n\u003cli\u003eDu JY, Wang JH, Coquillard CL, et al (2021) Comparing Plastic Surgeon Versus Orthopedic Surgeon Outcomes Following Distal Upper Extremity Amputations: A Study of the National Surgical Quality Improvement Program (NSQIP) Database. Plast Surg 29:110\u0026ndash;117. https://doi.org/10.1177/2292550320947834\u003c/li\u003e\n\u003cli\u003eAziz KT, Nayar SK, LaPorte DM, et al (2022) Impact of Missing Data on Identifying Risk Factors for Postoperative Complications in Hand Surgery. HAND 17:1257\u0026ndash;1263. https://doi.org/10.1177/15589447211023867\u003c/li\u003e\n\u003cli\u003eCotton J, Cabot J, Buckner J, et al (2022) Increased Frailty Associated with Higher Long-Term Mortality after Major Lower Extremity Amputation. Ann Vasc Surg 86:295\u0026ndash;304. https://doi.org/10.1016/j.avsg.2022.04.007\u003c/li\u003e\n\u003cli\u003ePandit V, Tan T-W, Kempe K, et al (2021) Frailty Syndrome in Patients With Lower Extremity Amputation: Simplifying How We Calculate Frailty. J Surg Res 263:230\u0026ndash;235. https://doi.org/10.1016/j.jss.2020.12.038\u003c/li\u003e\n\u003cli\u003eCasciato DJ, Kirkham K, Wynes J (2024) 30-Day Readmission Following Outpatient Transmetatarsal Amputation in the Geriatric Population: An ACS NSQIP Analysis. J Foot Ankle Surg 63:55\u0026ndash;58. https://doi.org/10.1053/j.jfas.2023.08.013\u003c/li\u003e\n\u003cli\u003eSareh S, Ugarte R, Dobaria V, et al (2020) Impact of Frailty on Clinical and Financial Outcomes Following Minor Lower Extremity Amputation: A Nationwide Analysis. Am Surg 86:1312\u0026ndash;1317. https://doi.org/10.1177/0003134820964230\u003c/li\u003e\n\u003cli\u003ePandit V, Nelson P, Kempe K, et al (2020) Racial and ethnic disparities in lower extremity amputation: Assessing the role of frailty in older adults. Surgery 168:1075\u0026ndash;1078. https://doi.org/10.1016/j.surg.2020.07.015\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. The association of patient demographics and comorbidities and Risk Analysis Index (RAI) tiers.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCOPD, Chronic Obstructive Pulmonary Disease; CHF, Congestive Heart Failure; mFI-5, Modified Frailty Index-5; RAI, Risk Analysis Index; GNRI, Geriatric Nutritional Risk Index.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=829)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot frail (RAI \u0026le; 20) (n=522)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrefrail (RAI = 21\u0026ndash;30) (n=248)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrail (RAI = 31\u0026ndash;40) (n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeverely frail (RAI \u0026ge; 41) (n=5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (yr)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e58.8 \u0026plusmn; 11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e53.6 \u0026plusmn; 9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e67.8 \u0026plusmn; 9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e66.8 \u0026plusmn; 9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e71.6 \u0026plusmn; 12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex, male\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e829 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e522 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e248 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e54 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e607 (73.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e383 (73.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e187 (75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e32 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e161 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e98 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e46 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17 (31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eAAPI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e43 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e28 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e13 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eAmerican Indian/Alaska Native\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e18 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e13 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass index (kg/m\u0026sup2;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e31.3 \u0026plusmn; 8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e31.5 \u0026plusmn; 8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e31.5 \u0026plusmn; 8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e28.7 \u0026plusmn; 9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e32.0 \u0026plusmn; 11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctional status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eIndependent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e678 (84.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e501 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e170 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003ePartially dependent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e104 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e9 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e66 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e28 (52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eTotally dependent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e25 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eInsulin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e598 (72.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e371 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e177 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e46 (85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eOral medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e231 (27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e151 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e71 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOPD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e67 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e22 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e33 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e53 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e24 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19 (35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent smoker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e210 (25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e147 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e55 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyspnea at rest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e78 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e17 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e47 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e13 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e635 (76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e375 (71.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e208 (83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e48 (88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisseminated cancer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSteroid use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e52 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e21 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e24 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e17 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003emFI-5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eNot frail (mFI-5 = 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e54 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e46 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003ePrefrail (mFI-5 = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e243 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e188 (36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e55 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eFrail (mFI-5 = 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e367 (44.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e254 (48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e99 (39.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e13 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eSeverely frail (mFI-5 \u0026ge; 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e165 (19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e34 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e86 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e41 (75.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGNRI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026gt;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e413 (49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e270 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e121 (48.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 (37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e92\u0026ndash;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e133 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e78 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e50 (20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e82-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e149 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e99 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e40 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026lt;82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e134 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e75 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e37 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 (37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e4 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e4 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e79 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e68 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e11 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e480 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e322 (61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e134 (54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e23 (42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e266 (32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e128 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e103 (41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e31 (57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay after operation (day)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e4.1 \u0026plusmn; 6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3.7 \u0026plusmn; 6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4.4 \u0026plusmn; 7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.9 \u0026plusmn; 8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e12.0 \u0026plusmn; 10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e41.5 \u0026plusmn; 33.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e40.1 \u0026plusmn; 34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e41.9 \u0026plusmn; 31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e47.6 \u0026plusmn; 32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e93.4 \u0026plusmn; 45.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: Data are presented as n (%) or mean \u0026plusmn; standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (\u0026gt;75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. 30-day outcome measures including mortality, nonroutine discharge, extended Length of Stay (eLOS), occurrence of complication, major complications, reoperation, and readmission among Risk Analysis Index (RAI) tiers.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=829)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot frail (RAI \u0026le; 20) (n=522)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrefrail (RAI = 21\u0026ndash;30) (n=248)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrail (RAI = 31\u0026ndash;40) (n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeverely frail (RAI \u0026ge; 41) (n=5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e18 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e5 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNonroutine discharge destination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e104 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e34 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e39 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e14 (26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eeLOS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e192 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e105 (20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e65 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e19 (35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e96 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e57 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e35 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMajor complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e92 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e52 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e35 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReadmission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e113 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e64 (12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e38 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.440\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReoperation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e84 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e46 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e30 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.383\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: Data are presented as n (%) or mean \u0026plusmn; standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (\u0026gt;75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. 30-day outcome measures including mortality, nonroutine discharge, extended Length of Stay (eLOS), occurrence of complication, major complications, reoperation, and readmission among Geriatric Nutritional Risk Index (GNRI) tiers.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=829)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGNRI \u0026gt;98 (n=413)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGNRI =92\u0026ndash;98 (n=133)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGNRI =82-91 (n=149)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGNRI \u0026lt;82 (n=134)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e18 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNonroutine discharge destination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e91 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e22 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e10 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e24 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e35 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eeLOS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e192 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e52 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e27 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e55 (36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e58 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e96 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e23 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e15 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e32 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e26 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMajor complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e92 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e15 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e32 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e26 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReadmission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e113 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e40 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e18 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e24 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e31 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReoperation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e84 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e27 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e12 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e22 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e23 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: Data are presented as n (%) or mean \u0026plusmn; standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (\u0026gt;75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Univariate logistic regression analysis of GNRI and RAI and major postoperative measures in surgery patients.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGNRI; Geriatric Nutritional Risk Index, RAI; Risk Analysis Index. Patient groups with GNRI \u0026gt; 98 and RAI \u0026le; 20 were the reference for GNRI and RAI regression analyses, respectively.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGNRI category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio (95% confidence interval)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRAI category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio (95% confidence interval)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e92\u0026ndash;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3.18 (0.65-15.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e21\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.64 (0.46-5.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e82-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.67 (1.45-22.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e31\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15.38 (5.36-44.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt;82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6.44 (1.65-25.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026ge; 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e61.67 (9.07-419.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNonroutine discharge destination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e92\u0026ndash;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.45 (0.68-3.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e21\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.72 (1.69-4.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e82-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3.34 (1.89-5.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e31\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.14 (2.64-10.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt;82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6.27 (3.66-10.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026ge; 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e54.00 (5.75-506.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eeLOS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e92\u0026ndash;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.77 (1.07-2.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e21\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.40 (1.00-1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e82-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.15 (2.73-6.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e31\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.18 (1.22-3.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt;82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.20 (3.39-7.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026ge; 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6.00 (1.07-33.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e92\u0026ndash;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.13 (1.17-3.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e21\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.34 (0.86-2.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e82-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.59 (2.74-7.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e31\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.66 (0.23-1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt;82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.05 (2.38-6.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026ge; 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMajor complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e92\u0026ndash;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.61 (1.33-5.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e21\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.47 (0.92-2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e82-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.58 (3.24-9.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e31\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.92 (0.35-2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt;82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.92 (2.81-8.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026ge; 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReadmission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e92\u0026ndash;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.45 (0.81-2.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e21\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.29 (0.83-2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e82-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.79 (1.07-2.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e31\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.61 (0.77-3.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt;82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.80 (1.75-4.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026ge; 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.78 (0.21-15.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReoperation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e92\u0026ndash;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.42 (0.72-2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e21\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.42 (0.88-2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e82-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.47 (1.41-4.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e31\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.54 (0.66-3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026lt;82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.93 (1.69-5.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026ge; 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.54 (0.30-21.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: Data are presented as n (%) or mean \u0026plusmn; standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (\u0026gt;75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Multivariable regression analysis of major complications and American Society of Anesthesiologists physical status class risk stratification system (ASA), Geriatric Nutritional Risk Index (GNRI), Risk Analysis Index (RAI), and Preoperative Acute Severe Condition (PACS).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted odds ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval - Lower Bound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval - Upper Bound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePACS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGNRI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRAI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: Data are presented as n (%) or mean \u0026plusmn; standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (\u0026gt;75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. AUC with 95% confidence interval for the American Society of Anesthesiologists (ASA) physical status class risk stratification system (ASA), Geriatric Nutritional Risk Index (GNRI), Risk Analysis Index (RAI), and Combined GNRI-ASA-RAI-PACS (CARP) and post-operative outcomes.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe DeLong test was used to compare all indices against the novel compound score. AUC; Area Under the receiver operating characteristic Curve.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"616\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAUC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMajor complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.770\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinor complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.680\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNonroutine discharge destination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eeLOS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.621\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReadmission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.633\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReoperation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.662\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: Data are presented as n (%) or mean \u0026plusmn; standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (\u0026gt;75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Internal validation of Area Under the Receiver operating Curve analysis of American Society of Anesthesiologists physical status class risk stratification system (ASA), Geriatric Nutritional Risk Index (GNRI), Risk Analysis Index (RAI), and Combined GNRI-ASA-RAI-PACS (CARP) by bootstrapping replications.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial AUC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInternal Validation AUC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBias-Corrected Confidence Intervals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower bound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMajor complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.741\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinor complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.811\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.680\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.340\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNonroutine discharge destination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eeLOS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.504\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReadmission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReoperation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eCARP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eRAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eGNRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003emFI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: Data are presented as n (%) or mean \u0026plusmn; standard deviation unless otherwise specified. CARP = Combined GNRI-ASA-RAI-PACS score; eLOS = extended length of stay (\u0026gt;75th percentile = 6 days); Major complications = composite of serious adverse events including MI, PE, DVT, sepsis, septic shock, deep SSI, prolonged ventilation, unplanned intubation, stroke, and postoperative dialysis.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6781675/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6781675/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003cbr\u003e\n \u003c/strong\u003eUpper extremity amputation in diabetic male patients presents a high-risk surgical scenario with substantial morbidity. Traditional risk models often fail to capture the multifactorial complexity of this population. This study aimed to validate the Combined ASA–RAI–Preoperative Acute Severe Condition (CARP) score as a composite frailty index to improve risk stratification.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003cbr\u003e\n \u003c/strong\u003eA retrospective cohort study was performed using the ACS-NSQIP database (2015–2021). Adult male diabetic patients undergoing upper extremity amputation were identified using CPT codes. Patients with cancer, infection, emergency surgery, age ≥90, or missing data were excluded. Frailty indices including RAI, ASA, PACS, GNRI, and mFI-5 were analyzed. Multivariable logistic regression and AUROC analysis were used to evaluate predictive performance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003cbr\u003e\n \u003c/strong\u003eAmong 829 patients, PACS and GNRI were the strongest individual predictors of adverse outcomes. The CARP score outperformed all individual indices across major complications (AUROC 0.748), mortality (2.17%), non-home discharge (11.1%), and extended length of stay (23.2%). Bootstrap validation confirmed minimal optimism bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003cbr\u003e\n \u003c/strong\u003eThe CARP score offers superior predictive accuracy for adverse postoperative outcomes in diabetic male patients undergoing upper extremity amputation and should be considered for clinical implementation.\u003c/p\u003e","manuscriptTitle":"Redefining Risk Assessment for Upper Extremity Amputation in Male Diabetic Patients: A National Analysis of Outcomes Using ACS-NSQIP Data (2015–2021)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-04 09:46:48","doi":"10.21203/rs.3.rs-6781675/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f698e7c3-82c0-4c5e-b342-081c3aca7864","owner":[],"postedDate":"June 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T03:08:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-04 09:46:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6781675","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6781675","identity":"rs-6781675","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}