Enhanced Predictive Accuracy of the Revised Risk Analysis Index Over the 5-Factor Modified Frailty Index for Postoperative Outcomes in Olecranon Fractures

ObjectiveTo compare the predictive accuracy of the Risk Analysis Index (RAI) versus the 5-factor Modified Frailty Index (mFI-5) for postoperative outcomes in olecranon fracture open reduction internal fixation (ORIF). MethodsThis retrospective study analyzed 3,987 patients from the ACS-NSQIP database who underwent olecranon ORIF between 2015-2020. Outcomes included 30-day mortality, non-home discharge (NHD), complications, readmission, and extended length of stay. Predictive accuracy was assessed using area under ROC curves (AUROC). ResultsRAI demonstrated superior predictive accuracy for NHD (AUROC: 0.81 vs 0.68, p<0.001), major complications (AUROC: 0.72 vs 0.65, p=0.05), and reoperation (AUROC: 0.63 vs 0.57, p=0.03) compared to mFI-5. Severely frail patients identified by RAI showed significantly increased odds for NHD (OR: 4.78, p=0.005), extended length of stay (OR: 2.83, p=0.008), and major complications (OR: 9.23, p=0.03). No significant differences were found between indices for mortality, minor complications, or readmission rates. ConclusionThe RAI demonstrates superior discriminatory accuracy compared to mFI-5 for predicting adverse outcomes after olecranon ORIF, particularly for NHD and major complications. Implementation of RAI in preoperative assessment may improve risk stratification and resource allocation for olecranon fracture patients.