DSAI-07 ACS SURGICAL RISK CALCULATOR OUTPERFORMS TRADITIONAL FRAILTY METRICS IN CNS METASTASIS SURGERY

Abstract Frailty is a known risk factor for poor surgical outcomes, yet its predictive value in patients with CNS metastases remains underexplored. This study compares the predictive performance of frailty and nutritional indices in patients undergoing craniectomy for CNS metastases. We conducted a retrospective analysis of 9,899 patients from the 2016–2022 ACS NSQIP database, evaluating the ACS Surgical Risk Calculator (SRC), Modified Frailty Index-5 (mFI-5), Geriatric Nutritional Risk Index (GNRI), and Risk Analysis Index (RAI) across 33 postoperative complications using area under the receiver operating characteristic curve (AUC) and odds ratios (ORs). The ACS SRC demonstrated the highest predictive accuracy for most immediate complications, including failure to wean from a ventilator (AUC 0.696), pneumonia (AUC 0.694), unplanned reintubation (AUC 0.665), wound dehiscence (AUC 0.640), and sepsis (AUC 0.631). In comparison, GNRI showed lower predictive ability for these outcomes, including AUCs of 0.566 for ventilator weaning, 0.616 for pneumonia, and 0.513 for sepsis. mFI-5 and RAI also underperformed; for example, AUCs for failure to wean were 0.580 (mFI-5) and 0.589 (RAI). For severe outcomes, the ACS SRC again led, achieving AUCs of 0.733 for death, 0.709 for cardiac arrest, and 0.661 for withdrawal of end-of-life care. ACS SRC was significantly associated with cardiac arrest (OR 1.11, 95% CI: 1.06–1.16, p < 0.001), outperforming mFI-5 (OR 1.38, 95% CI: 0.71–2.68, p = 0.34) and RAI (OR 1.07, 95% CI: 1.00–1.15, p = 0.05). These findings suggest that the ACS SRC provides more accurate and consistent risk estimates than traditional frailty or nutritional indices. Its integration of clinical, physiologic, and procedural factors makes it the most reliable tool for preoperative planning and risk stratification in patients with CNS metastases.