Modified frailty index versus risk analysis index for 30-day mortality after noncardiac surgery: a systematic review and meta-analysis.

Authors

Xinrui Yin, Shijia Du

Published in

Frontiers in medicine. Volume 13. Pages 1885620. Epub Oct 09, 2026.

Abstract

mFI and RAI are widely used in noncardiac surgical risk stratification, but they differ in content and data requirements. Because construct validity and outcome discrimination are distinct, we evaluated their prognostic discrimination for 30-day all-cause mortality without treating either instrument as a criterion-standard multidimensional frailty measure.
This PRISMA-aligned, prospectively registered systematic review used two complementary evidence levels: tool-specific random-effects meta-analyses across independent cohorts and direct within-study comparison. Standalone AUCs were pooled on the logit scale using REML with Hartung-Knapp inference and 95% prediction intervals. Risk of bias was assessed with QUIPS. CFS was analyzed post hoc as secondary exploratory evidence.
Seventy-seven studies were included. For mFI, 39 independent cohorts yielded a pooled AUC of 0.634 (95% CI, 0.618-0.649; 95% prediction interval, 0.551-0.709). For RAI, 30 independent cohorts yielded 0.767 (95% CI, 0.737-0.795; 95% prediction interval, 0.579-0.888). Among 29 dual-tool studies, 21 had source-valid numeric comparisons in which RAI was higher, none had a source-valid numeric comparison in which mFI was higher, 2 supported RAI only qualitatively, and 6 could not be numerically classified; no paired meta-analysis was conducted because within-study covariance or delta-AUC standard errors were unavailable. Fourteen CFS studies were identified; 6 source-confirmed 30-day AUC cohorts yielded a post hoc exploratory AUC of 0.757 (95% CI, 0.618-0.857).
RAI showed higher average prognostic discrimination than mFI, a pattern also observed in most directly comparative studies. Separate pooled AUCs are not a formal superiority test because case mix differs across studies. The analysis does not establish construct validity, and CFS evidence remains exploratory.
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261378778, identifier PROSPERO, CRD420261378778.

PMID:
42920572
Bibliographic data and abstract were imported from PubMed on 24 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.