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Peer-reviewedCC BY 4.0International Forum of Allergy & Rhinology

A Comparison of Frailty Indices in Predicting Postoperative Outcomes After Endoscopic Sinus Surgery

  • Akshay Warrier1
  • David Remyes2
  • Tenesha Boyd3
  • Ailish Nagpal4
  • Aman M Patel1
  • David W. Wassef1
  • Jean Anderson Eloy1,5
5 affiliations
  1. 1Department of Otolaryngology‐Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
  2. 2Department of Osteopathic Manipulative Medicine College of Osteopathic Medicine New York Institute of Technology Old Westbury New York USA
  3. 3Department of Otolaryngology Meharry Medical College Nashville Tennessee USA
  4. 4Department of Otolaryngology Aram V. Chobanian & Edward Avedisian School of Medicine Boston University Boston Massachusetts USA
  5. 5Center for Skull Base and Pituitary Surgery Neurological Institute of New Jersey Rutgers New Jersey Medical School Newark New Jersey USA
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Abstract

Objective: To compare the discriminatory performance of the Risk Analysis Index (RAI) and modified Frailty Index‐5 (mFI‐5) in predicting postoperative outcomes following endoscopic sinus surgery (ESS).

Study Design: Retrospective cohort study.

Methods: Adult ESS patients were identified from the ACS‐NSQIP database (2005–2020). Frailty was quantified using the RAI and mFI‐5. Multivariable logistic regression evaluated associations between frailty strata and postoperative outcomes, including Clavien–Dindo (CD) complications, extended length of stay (eLOS), non‐home discharge (NHD), wound complications, and mortality. Model discrimination was assessed using receiver operating characteristic analysis with area under the curve (AUC) as the primary comparative metric.

Results: Among 1871 patients, increasing frailty was independently associated with adverse postoperative outcomes across both indices. However, discriminatory performance differed meaningfully. The RAI demonstrated superior discrimination for NHD (AUC 0.796 vs. 0.721), CD II complications (0.722 vs. 0.547), and mortality (0.742 vs. 0.684), and CD IV (0.737 vs. 0.656), with comparable performance for eLOS (0.647 vs. 0.636). Overall, the RAI more consistently separated patients at risk for recovery‐ and disposition‐related endpoints.

Conclusion: Frailty is a significant predictor of postoperative outcomes after ESS. While both indices identified elevated risk, the RAI demonstrated stronger and more consistent discrimination across clinically meaningful endpoints, particularly those reflecting postoperative recovery and resource utilization. Multidomain frailty assessment may therefore provide more informative risk stratification than comorbidity‐based tools in elective rhinologic surgery.

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Cite

BibTeXRIS
BibTeX
@article{warrier2026comparison,
  title = {{A Comparison of Frailty Indices in Predicting Postoperative Outcomes After Endoscopic Sinus Surgery}},
  author = {Akshay Warrier and David Remyes and Tenesha Boyd and Ailish Nagpal and Aman M Patel and David W. Wassef and Jean Anderson Eloy},
  journal = {International Forum of Allergy \& Rhinology},
  year = {2026},
  month = jul,
  doi = {10.1002/alr.70212},
  url = {https://doi.org/10.1002/alr.70212},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - A Comparison of Frailty Indices in Predicting Postoperative Outcomes After Endoscopic Sinus Surgery
AU  - Akshay Warrier
AU  - David Remyes
AU  - Tenesha Boyd
AU  - Ailish Nagpal
AU  - Aman M Patel
AU  - David W. Wassef
AU  - Jean Anderson Eloy
PY  - 2026
DA  - 2026/07/02
JO  - International Forum of Allergy & Rhinology
DO  - 10.1002/alr.70212
UR  - https://doi.org/10.1002/alr.70212
AB  - Objective: To compare the discriminatory performance of the Risk Analysis Index (RAI) and modified Frailty Index‐5 (mFI‐5) in predicting postoperative outcomes following endoscopic sinus surgery (ESS).  Study Design: Retrospective cohort study.  Methods: Adult ESS patients were identified from the ACS‐NSQIP database (2005–2020). Frailty was quantified using the RAI and mFI‐5. Multivariable logistic regression evaluated associations between frailty strata and postoperative outcomes, including Clavien–Dindo (CD) complications, extended length of stay (eLOS), non‐home discharge (NHD), wound complications, and mortality. Model discrimination was assessed using receiver operating characteristic analysis with area under the curve (AUC) as the primary comparative metric.  Results: Among 1871 patients, increasing frailty was independently associated with adverse postoperative outcomes across both indices. However, discriminatory performance differed meaningfully. The RAI demonstrated superior discrimination for NHD (AUC 0.796 vs. 0.721), CD II complications (0.722 vs. 0.547), and mortality (0.742 vs. 0.684), and CD IV (0.737 vs. 0.656), with comparable performance for eLOS (0.647 vs. 0.636). Overall, the RAI more consistently separated patients at risk for recovery‐ and disposition‐related endpoints.  Conclusion: Frailty is a significant predictor of postoperative outcomes after ESS. While both indices identified elevated risk, the RAI demonstrated stronger and more consistent discrimination across clinically meaningful endpoints, particularly those reflecting postoperative recovery and resource utilization. Multidomain frailty assessment may therefore provide more informative risk stratification than comorbidity‐based tools in elective rhinologic surgery.
SN  - 2042-6976
SN  - 2042-6984
ER  -