JOA - 2026-09-01 - Journal Article
The Risk Analysis Index is Superior to the Modified 5-Factor Frailty Index for Predicting 30-Day Mortality Following Arthroplasty for Femoral Neck Fractures.
Parisier E, Koltenyuk V, Gupta N, Wang L, Perugini A, Weick J
Topics
Key Takeaway
The Risk Analysis Index outperforms the Modified 5-Item Frailty Index for predicting 30-day mortality after arthroplasty for femoral neck fractures, with C-statistics of 0.84 vs 0.69 for THA and 0.74 vs 0.62 for hemiarthroplasty.
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Summary
This study compared the predictive accuracy of the RAI versus mFI-5 for 30-day mortality in patients undergoing HA or THA for femoral neck fractures using a national database (2015–2020). Both tools independently predicted mortality in multivariate regression; RAI OR was 1.46 for HA and 1.15 for THA, while mFI-5 OR was 1.10 for HA and 1.50 for THA. ROC analysis demonstrated RAI superiority in risk discrimination for both procedures (HA: 0.74 vs 0.62; THA: 0.84 vs 0.69).
Key Limitation
The 30-day follow-up window captures only early mortality, leaving the predictive utility of RAI versus mFI-5 for 90-day mortality, major complications, and functional outcomes entirely uncharacterized.
Original Abstract
BACKGROUND
Femoral neck fractures (FNFs) are common in the elderly and are typically treated operatively. Tools like frailty assessments may be critical for evaluating peri- and postoperative patient needs. Our study evaluated the utility of frailty, measured by the Risk Analysis Index (RAI) and the Modified 5-Item Frailty Index (mFI-5), in predicting 30-day mortality in patients undergoing hemiarthroplasty (HA) or total hip arthroplasty (THA) for FNFs.
METHODS
A national database was queried from 2015 to 2020 for patients 18 years of age or older undergoing HA or THA for FNFs. A total of 14,913 patients who had surgically managed FNFs were included. The primary outcome was 30-day mortality. Multivariate regressions were used to evaluate predictive value, and receiver operating characteristic curves assessed frailty accuracy.
RESULTS
Frailty as measured by the mFI-5 and RAI was predictive of increased odds of 30-day mortality in HA (RAI = odds ratio (OR): 1.46, 95% confidence interval (CI): 1.31 to 1.64; mFI-5 = OR: 1.10 (1.08 to 1.12, P < 0.001 for both)) and THA (RAI = OR: 1.15 (CI: 1.106 to 1.190, P < 0.001), mFI-5 = OR: 1.50 (CI: 1.167 to 1.923, P = 0.002)). The RAI demonstrated superior risk discrimination when compared to the mFI-5 for THA (RAI = C-statistic: 0.84, 95% CI: 0.45 to 0.83 versus mFI-5 = C-statistic: 0.69, 95% CI: 0.68 to 0.71) and HA (RAI = C-statistic: 0.74, 95% CI: 0.73 to 0.75 versus mFI-5 = C-statistic: 0.62, 95% CI: 0.61 to 0.63).
CONCLUSION
Frailty was found to be a predictor of mortality in patients who had FNFs undergoing THA and HA. Compared to the mFI-5, the RAI demonstrated superior predictive value for mortality across both operations. Thus, the RAI may be a powerful tool for assessing preoperative risk in patients undergoing arthroplasty for FNFs.