The revised risk analysis index outperforms the 5-factor modified frailty index in predicting postoperative morbidity after pilon fracture fixation

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-08-16 DOI:10.1016/j.jor.2025.08.022

Gabriel DeOliveira , Amber Park , Arsalaan Sayyed , Aruni Areti , Nithin Gupta , Taylor Manes , Morgan Turnow , Benjamin Taylor , Jack W. Weick

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引用次数: 0

Abstract

Background

Pilon fractures often result from high energy mechanisms resulting in long-term morbidity and postoperative complications. While there is extensive literature investigating frailty scales as tools for preoperative risk stratification in orthopedic surgery, there is no literature regarding their use in fixation of pilon fractures. The objective of this study was to compare the predictive ability and discriminative accuracy of the Revised Risk Analysis Index (RAI-rev) and the 5-Item Modified Frailty (mFI-5) in 30-day postoperative outcomes following surgical fixation of pilon fractures.

Methodology

The ACS-NSQIP database was used to identify patients undergoing surgical fixation of pilon fractures from 2015 to 2020. Multivariate analysis was used to analyze the predictive ability of frailty status for 30-day postoperative outcomes. Discriminatory accuracy of frailty scales was assessed using receiver operating characteristic analysis. Significance was determined by p < 0.05.

Results

This study included 2935 patients, aged 33–59, of which 53 % (1562/2935) were male. The RAI-rev categorized 44.2 % (1296/2935) as normal, 44.6 % (1309/2935) as frail, and 11.2 % (330/2935) as severely frail. The mFI-5 was a significant predictor of major complications, readmission, and CDIV complications for severely frail patients and of eLOS, and NHD in both frail and severely frail patients. The RAI-rev had superior discriminative accuracy for most outcomes with good discriminative ability for NHD compared to mFI-5 (0.79 vs 0.74).

Conclusion

This study demonstrated that compared to RAI-rev, mFI-5 is a significant predictor of postoperative complications after surgical fixation of pilon fractures, but RAI-rev had more accurate predictive ability when compared to mFI-5, most notable for NHD (AUC 0.79 vs 0.74). However, ROC values for both RAI (AUC 0.65–0.79) and mFI-5 (AUC 0.59–0.74) still fell below an AUC of 0.80 indicating that overall frailty is not a strong predictor of outcomes. These findings support the need for further research into preoperative risk assessment in pilon fracture patients.

Level of evidence

III – retrospective cohort study.

查看原文本刊更多论文

修正后的风险分析指数在预测头枕骨折固定术后发病率方面优于修正后的五因素脆弱指数

背景：皮隆骨折通常由高能量机制引起，导致长期发病率和术后并发症。虽然有大量的文献研究衰弱量表作为骨科手术术前风险分层的工具，但没有文献研究衰弱量表在枕部骨折固定中的应用。本研究的目的是比较修订风险分析指数（raiv）和5项修订脆弱指数（mFI-5）在头枕骨折手术固定后30天预后的预测能力和判别准确性。方法采用ACS-NSQIP数据库，对2015 - 2020年接受枕部骨折手术固定的患者进行分析。采用多变量分析分析衰弱状态对术后30天预后的预测能力。采用受者工作特征分析对脆弱量表的鉴别准确性进行评价。p <； 0.05为差异有显著性。结果纳入2935例患者，年龄33-59岁，其中男性占53%（1562/2935）。RAI-rev将44.2%（1296/2935）归类为正常，44.6%（1309/2935）为虚弱，11.2%（330/2935）为严重虚弱。mFI-5是严重虚弱患者的主要并发症、再入院和CDIV并发症以及虚弱和严重虚弱患者的eLOS和NHD的重要预测因子。与mFI-5相比，RAI-rev在大多数结果中具有更好的判别准确度，对NHD具有良好的判别能力（0.79 vs 0.74）。结论本研究表明，与RAI-rev相比，mFI-5是预测pilon骨折手术固定术后并发症的重要指标，但与mFI-5相比，RAI-rev具有更准确的预测能力，最显著的是NHD （AUC 0.79 vs 0.74）。然而，RAI （AUC 0.65-0.79）和mFI-5 （AUC 0.59-0.74）的ROC值仍低于0.80，表明整体虚弱不是预后的有力预测因子。这些发现支持了进一步研究枕部骨折患者术前风险评估的必要性。证据水平ii -回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.