Objective To 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).

Methods This 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).

Results RAI 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.

Conclusion The 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.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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Ethics Statement: This study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, which is a de-identified, publicly available dataset. As such, this study did not involve direct interaction with human participants and did not require Institutional Review Board (IRB) approval. Participant consent was not required, and the need for informed consent was waived by the data provider due to the de-identified nature of the dataset, in accordance with institutional and national guidelines.

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