1057 Predictive Value of Risk Analysis Index and Geriatric Nutritional Risk Index for Post-Operative Outcomes in Spine Surgery Patients: A Comprehensive Analysis

INTRODUCTION: Frailty and nutritional status have been strongly associated with postoperative outcomes in spine surgery. METHODS: Data was sourced from the National Surgical Quality Improvement Program database (2015–2020). The predictive capacity of multiple indices was analyzed, including RAI, GNRI, and American Society of Anesthesiologists physical status class risk stratification system (ASA), across post-operative mortality, morbidity, and length of stay in patients undergoing spine surgery. Patient demographics, comorbidities, and surgical parameters across various RAI tiers were studied, elucidating the influence of frailty on surgical outcomes. Moreover, a compound score utilizing RAI, GNRI, and ASA was developed. The model’s discriminatory accuracy was assessed in area under the receiver operating characteristics (AUROC) curve analysis. RESULTS: A total of 362,879 spine surgery patients were identified. Higher frailty tiers were associated with an increased prevalence of adverse postoperative outcomes. The predictive performance of the combined RAI-GNRI model ranged from 0.619 for reoperation to 0.882 for mortality. The novel compound score demonstrated superior predictive performance for postoperative outcomes compared to individual indices, with robust discriminatory ability across various measures including mortality (AUC= 0.882), nonroutine discharge (AUC= 0.762), extended length of stay (AUC= 0.686), complications (AUC= 0.694), and readmission (AUC= 0.641). CONCLUSIONS: Our study highlights the critical role of frailty and nutritional status in predicting post-operative outcomes in spine surgery patients. RAI and GNRI demonstrated strong predictive value across various outcome measures. Importantly, our novel compound score integrating RAI, GNRI, and ASA exhibited superior predictive performance in comparison to each score independently, offering potential to enhance spine surgery care and risk stratification.