Arya et al reported a revised version of the Risk Analysis Index (RAI) for evaluation of surgical patients. This recalibrates some of the parameters to improve accuracy. The authors are from multiple Veterans Affairs hospitals and affiliated universities in the United States.
Patient selection: surgical patient
Outcomes: 30, 180 and 365 day mortality
Parameters:
(1) sex
(2) age in years
(3) presence of cancer (excluding minor skin cancers)
(4) unintended weight loss in the past 3 months > 10 pounds
(5) renal failure
(6) chronic or congestive heart failure
(7) poor appetite
(8) shortness of breath at rest
(9) living (independent vs other facility)
(10) mobility and locomotion
(11) eating
(12) toilet use
(13) personal hygiene
(14) cognitive decline over the past 3 months
|
Age |
Points without Cancer |
Points with Cancer |
|
<= 19 |
0 |
28 |
|
20 to 24 |
1 |
29 |
|
25 to 29 |
4 |
29 |
|
30 to 34 |
6 |
30 |
|
35 to 39 |
8 |
30 |
|
40 to 44 |
10 |
31 |
|
45 to 49 |
12 |
31 |
|
50 to 54 |
14 |
32 |
|
55 to 59 |
16 |
32 |
|
60 to 64 |
18 |
33 |
|
65 to 69 |
20 |
34 |
|
70 to 74 |
22 |
34 |
|
75 to 79 |
24 |
35 |
|
80 to 84 |
26 |
35 |
|
85 to 89 |
28 |
36 |
|
90 to 94 |
30 |
36 |
|
95 to 99 |
32 |
37 |
|
>= 100 |
34 |
37 |
|
Parameter |
Finding |
Points |
|
sex |
female |
0 |
|
|
male |
3 |
|
unintended weight loss |
no |
0 |
|
|
yes |
4 |
|
renal failure |
no |
0 |
|
|
yes |
8 |
|
heart failure |
no |
0 |
|
|
yes |
5 |
|
poor appetite |
no |
0 |
|
|
yes |
4 |
|
shortness of breath at rest |
no |
0 |
|
|
yes |
3 |
|
living independent |
yes |
0 |
|
|
no |
1 |
subscore for the 7 parameters =
= SUM(points for first 7 parameters)
|
Parameter |
Finding |
Points |
|
mobility/locomotion |
independent |
0 |
|
|
supervised |
1 |
|
|
limited assistance |
2 |
|
|
extensive assistance |
3 |
|
|
total dependence |
4 |
|
eating |
independent |
0 |
|
|
supervised |
1 |
|
|
limited assistance |
2 |
|
|
extensive assistance |
3 |
|
|
total dependence |
4 |
|
toilet use |
independent |
0 |
|
|
supervised |
1 |
|
|
limited assistance |
2 |
|
|
extensive assistance |
3 |
|
|
total dependence |
4 |
|
personal hygiene |
independent |
0 |
|
|
supervised |
1 |
|
|
limited assistance |
2 |
|
|
extensive assistance |
3 |
|
|
total dependence |
4 |
subscore for activities of daily living =
= SUM(points for the 4 parameters)
|
Subscore for ADL |
Without Cognitive Deficit |
With Cognitive Deficit |
|
0 |
0 |
5 |
|
1 |
1 |
6 |
|
2 |
2 |
6 |
|
3 |
3 |
7 |
|
4 |
4 |
8 |
|
5 |
4 |
8 |
|
6 |
5 |
9 |
|
7 |
6 |
10 |
|
8 |
7 |
11 |
|
9 |
8 |
11 |
|
10 |
9 |
12 |
|
11 |
10 |
13 |
|
12 |
11 |
13 |
|
13 |
11 |
14 |
|
14 |
12 |
15 |
|
15 |
13 |
15 |
|
16 |
14 |
16 |
total score =
= (points for age and cancer status) + (points for 7 parameters) + (points for ADL plus cognitive status)
Interpretation:
• minimum score: 0
• maximum score: 81
• The higher the score the greater the patient's frailty.
• If the score is determined prospectively, then the score is designated RAI-C.
• If the score is determined retrospectively, then the score is designated RAI-A.
Performance:
• The area under the ROC curve ranges from 0.78 to 0.84 depending on outcome and cohort.
