(826) Comparison of the Risk Analysis Index versus Modified Frailty Index: Outcomes in Otologic Surgery

Introduction: Frailty reflects physiologic vulnerability and predicts adverse surgical outcomes, yet its optimal assessment in otologic surgery remains unclear. This study compared the predictive performance of the Modified 5-Item Frailty Index (mFI-5) and the Clinical Risk Analysis Index (RAI-C) for postoperative otologic surgical outcomes.

Methods: A retrospective chart review was conducted for patients undergoing otologic surgery excluding tympanostomy tubes at a quaternary care center from 2022-2025. Nominal logistic regression, stratified by procedure type and adjusted for age and sex, evaluated the discriminative ability of RAI-C versus mFI-5 for 30-day readmissions, 30-day return to OR, 30-day ED visit, skilled nursing, physical therapy, length of stay (LOS) > 1, and total complications.

Results: Among 261 patients, 169 (61.4%) had middle ear, 71 (25.8%) inner ear, and 21 (7.6%) skull base surgery. Both RAI-C (OR 1.08; 95% CI [1.00-1.16]; p= 0.02) and mFI-5 (OR 1.98; 95% CI [1.14-3.36]; p = 0.01) predicted total complications. Patients deemed frail by RAI-C had 1.22 times higher odds of 30-day readmissions (95% CI [1.11-1.37]; p < 0.01), whereas those deemed frail by mFI-5 had 2.15 times higher odds (95% CI [1.08-4.21]; p = 0.02). RAI-C better predicted LOS > 1 day (OR 1.07; 95% CI [1.01-1.13]; p < 0.01), 30-day ED visits (OR 1.08; 95% CI [0.98-1.17]; p = 0.03), and skilled nursing (OR 1.15; 95% CI [1.01-1.34]; p = 0.02), whereas mFI-5 was not a strong predictor for these outcome measures.

Conclusions: While both indices predict postoperative complications and 30-day readmissions, RAI-C more effectively identifies patients at risk for resource utilization and short-term adverse outcomes following ear surgery, suggesting its broader prognostic value for perioperative planning and postoperative resource needs.