(0228) Implementation of Risk Analysis Index Frailty Score Initiative in Head and Neck Surgery Patients

Introduction: Risk Analysis Index (RAI) score is a screening tool for patient frailty shown to be predictive of postoperative morbidity and mortality in various surgical specialties, but it has not been successfully implemented in otolaryngology. In this quality improvement (QI) initiative, we implemented a preoperative RAI score collection system. We describe this initiative and provide preliminary data on predictive quality of RAI score for postoperative complications in head and neck surgery patients.

Methods: A prospective QI project was commenced to include adult patients undergoing head and neck surgery at the University of California, Los Angeles from February 2022 to December 2023. RAI questionnaires were sent preoperatively through the EMR, which automatically calculated the score upon completion (range 0-81). Data analyzed included demographics, postsurgical outcomes, readmissions, and mortality. Categorical statistical analyses were performed using t-tests and chi-squared tests.

Results: An RAI flowsheet was configured into the EMR to send to patients upon scheduling for surgery. Adjunctive direct messaging improved response rate, resulting in a 60% response rate, and a total 517 RAI scores. Mean RAI score was 21.38 +/- 11.83. Mean RAI scores by sub-specialty for rhinology, otology, sleep, laryngology, head and neck, and facial plastic and reconstructive surgery (FPRS) were 15.8, 19.1, 21.8, 23.9, 24.8 and 28.2, respectively. Response rates by specialty were rhinology (57%), otology (49%), sleep (74%), laryngology (53%), head and neck (66%) and FPRS (78%). Age was not a factor in response rate. The mean RAI score in patients with any postoperative complication was 30.82 compared to 20.74 without (p < 0.0001).

Conclusions: We implemented RAI scoring in an otolaryngology surgery population and found RAI a useful predictor of postoperative complications. Future work is needed to streamline and automate this RAI initiative to increase response rates, utilize RAI scores in rounding discussions, and integrate RAI scores in the decision-making process for surgery as well as postoperative care.