Recalibration and External Validation of the Risk Analysis Index: A Surgical Frailty Assessment Tool.
Recalibration and External Validation of the Risk Analysis Index: A Surgical Frailty Assessment Tool.
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DOI：
10.1097/sla.0000000000003276
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发表时间：
2020-12
影响因子：
9
通讯作者：
Hall DE
中科院分区：
文献类型：
--
作者：
Arya S;Varley P;Youk A;Borrebach JD;Perez S;Massarweh NN;Johanning JM;Hall DE
风险分析指数(RAI)根据构成脆弱性的变量预测30天、180天和365天的死亡率。最初的验证是在一家单中心的退伍军人医院进行的，我们试图通过在大型的退伍军人外科注册中心重新校准RAI来改善模型性能，并在国家外科注册中心和手术患者队列中进行外部验证，这些患者的RAI在手术前进行了前瞻性测量。在退伍军人事务部外科质量改进计划(VASQIP；2010-2014；N=480,731)内的发展和确认样本中重新校准RAI，以创建修订的RAI(RAI-rev)，比较区分和校准。该模型在美国外科医师学会国家外科质量改进计划数据集(NSQIP；2005-2014；N=1,391,785)中进行了外部测试，并在从内布拉斯加州西部爱荷华州医疗保健系统VA(NWIHCS；N=6,856)前瞻性收集的队列中进行了测试。重新校正RAI显著改善了VASQIP患者的30天[c=0.84to0.86d]、180d[c=0.81to0.84]和365日死亡率[c=0.78to0.82p<；0.001]的差别。RAI-REV也有明显更好的校准(观察和预测180天死亡率的中位数绝对差异：从8.45%下降到1.23%)。在外部验证中，RAI-REV对30天死亡率有很高的预测性(c=0.87)，具有出色的校准性(观察和预测的30天死亡率之间的中位数绝对差异：0.6%)。这种歧视在男性(c=0.85)和女性(c=0.89)中表现得非常强烈。在NWIHCS对180d死亡率的前瞻性测量队列中，歧视也有所改善[c=0.77至0.8](p<；0.001)。RAI-REV作为外科患者的脆弱筛查工具，改善了辨别力和校准能力。它在广泛的手术环境中对男性和女性具有强大的外部有效性，并可立即实施，用于术前患者的风险评估和咨询。这项研究重新校准了先前开发的风险分析指数(RAI)，并使用国家外科队列和调查工具对其进行了外部验证。RAI在不同外科人群中的普适性使其成为术前患者脆弱性评估的理想工具。
The Risk Analysis Index (RAI) predicts 30, 180 and 365-day mortality based on variables constitutive of frailty. Initially validated, in a single-center Veteran hospital, we sought to improve model performance by recalibrating the RAI in a large, Veteran surgical registry, and to externally validate it in both a national surgical registry and a cohort of surgical patients for whom RAI was measured prospectively before surgery. The RAI was recalibrated among development and confirmation samples within the Veterans Affairs Surgical Quality Improvement Program (VASQIP; 2010–2014; N=480,731) including major, elective non cardiac surgery patients to create the revised RAI (RAI-rev), comparing discrimination and calibration. The model was tested externally in the American College of Surgeons National Surgical Quality Improvement Program dataset (NSQIP; 2005–2014; N=1,391,785), and in a prospectively collected cohort from the Nebraska Western Iowa Health Care System VA (NWIHCS; N=6,856). Recalibrating the RAI significantly improved discrimination for 30-day [c=0.84 to 0.86], 180-day [c=0.81 to 0.84] and 365-day mortality [c=0.78 to 0.82](p<0.001 for all) in VASQIP. The RAI-rev also had markedly better calibration (median absolute difference between observed and predicted 180-day mortality: decreased from 8.45% to 1.23%). RAI-rev was highly predictive of 30-day mortality (c=0.87) in external validation with excellent calibration (median absolute difference between observed and predicted 30-day mortality: 0.6%). The discrimination was highly robust in men (c=0.85) and women (c=0.89). Discrimination also improved in the prospectively measured cohort from NWIHCS for 180-day mortality [c=0.77 to 0.80] (p<0.001). The RAI-rev has improved discrimination and calibration as a frailty screening tool in surgical patients. It has robust external validity in men and women across a wide range of surgical settings and available for immediate implementation for risk assessment and counseling in preoperative patients. This study recalibrates the previously developed Risk Analysis Index (RAI) in a large Veteran surgical registry and externally validates it using a national surgical cohort and a survey instrument. The generalizability of the RAI across various surgical populations makes it an ideal instrument for frailty assessment in preoperative patients.