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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Presentation 5 - Head and Neck Surgery

RAI is Superior to mFI-5 in Predicting Postoperative Adverse Outcomes in Free Flap Surgery

Monday, October 13, 2025
1:18 PM - 1:24 PM EDT
Location: 127
Disclosure(s):
Akshay K. Warrier, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

John Sebastian De Armas, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Free flap surgery of the head and neck can be associated with significant morbidity and mortality. The Modified Frailty Index-5 (mFI-5) has been previously identified as an important risk stratification tool; however, the Risk Analysis Index (RAI) empirically offers a higher degree of physiologic assessment. Determination of an optimal risk-assessment tool is crucial.

Methods: The NSQIP database was queried for patients > 18 years of age from 2012 to 2020 who underwent head and neck free flap reconstruction. Multivariable analyses and Receiver Operating Characteristics (ROC) assessed postoperative outcomes with respect to RAI-A, mFI-5, and patient age. Primary outcomes included Clavien-Dindo (CD) II, IIIb, IV, mortality, extended length of stay (eLOS), and non-home discharge. Secondary outcomes included wound complications, any complication, and readmission.

Results: There were 2,959 patients included in this study, with a median age of 62 (IQR: 55-70). The majority were male (64.6%) and white (67.7%). On multivariate analysis the RAI demonstrated higher odds for CD IV, 30-day mortality, eLOS, non-home discharge (NHD), and any complication. The mFI-5 demonstrated higher odds for CDII, and surgical complications. When comparing the predictive performance of the RAI-A and mFI-5 using the ROC analyses for primary outcomes, the RAI demonstrated higher discriminatory accuracy for 30-Day Mortality (C-Statistic, RAI: 0.732 vs mFI: 0.667), eLOS (C-Statistic, RAI: 0.578 vs mFI: 0.541), and non-home discharge (C-Statistic, RAI: 0.666 vs mFI: 0.584).

Conclusions: The RAI demonstrated stronger independent associations compared to the mFI-5 and age for CD IV, 30-day mortality, eLOS, non-home discharge, and any complication. RAI-A had superior discrimination for 30-day mortality, eLOS, non-home discharge, and any complication compared to the mFI-5. The RAI may serve as a superior preoperative risk assessment tool in patients undergoing head and neck free flap reconstruction and may allow for a more precise measurement of postoperative prognosis and resource allocation in this population.

    Presenting Author(s)

  • Akshay K. Warrier, BA

    Medical Student
    Rutgers New Jersey Medical School
    Newark, NJ, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Author(s)

  • Rohini Bahethi, MD

    Resident Physician
    Rutgers New Jersey Medical School
    Jersey City, New Jersey, United States

    Disclosure information not submitted.

  • Paul T. Cowan, DO

    Resident Physician
    Rutgers New Jersey Medical School
    Kearny, NJ, United States

    Disclosure information not submitted.

    • Presenting Author(s)

  • John Sebastian De Armas, MD

    Resident Physician
    Rutgers New Jersey Medical School
    Newark, New Jersey, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Ghayoour S. Mir, DO

    Assistant Professor
    Rutgers New Jersey Medical School
    Newark, NJ, United States

    Disclosure information not submitted.