Risk Analysis Index Predicts Complications and Discharge Outcomes after Brain Tumor Resection Better than Patient Age and Modified Frailty Index-5

Purpose: To evaluate the discriminative prognostic utility of the Risk Analysis Index-Administrative (RAI-A) as compared to the modified frailty index-5 (mFI-5) and patient age for postoperative outcomes of brain tumor resection (BTR) patients. Methods: Patients with BTR were queried from the National Surgical Quality Improvement Program (NSIQP) for the years 2015 to 2019. Multivariable logistic regression was performed to evaluate the association between frailty tools and postoperative complications and discharge outcomes. Results: We identified 30,951 patients that underwent craniotomy for BTR; the median age of our study sample was 59 (IQR 47-68) years old and 47.8% of patients were male. Overall, increasing RAI-A score, in an overall stepwise fashion, was associated with increased post-operative outcomes including in-hospital mortality, non-routine discharge, major complications, Clavien-Dindo Grade IV complication, and extended length of stay. The RAI-A tiers 41-45 and >45 were ~4 (Odds Ratio [OR]: 4.3, 95% CI: 2.1-8.9) and ~9 (OR: 9.5, 95% CI: 3.9-22.9) more times more likely to have mortality compared to RAI-A 0-20. Multivariable regression analysis (adjusting for age, sex, BMI, non-elective surgery status, race, and ethnicity) demonstrated that RAI-A was an independent predictor of all BTR outcomes. Conclusions: and Relevance Increasing RAI-A score is a better predictor than the mFI-5 and increasing patient age for in-hospital complications and discharge outcomes in BTR patients. The RAI-A may help providers present better preoperative risk assessment for patients and families weighing the risks and benefits of potential BTR.