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September 3, 2026The Journal of ArthroplastyOpen Access

Risk Analysis Index outperforms mFI-5 in predicting 30-day mortality after hip arthroplasty.

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Why the study?

Frailty assessments may be critical for evaluating peri- and postoperative needs, but the utility of the Risk Analysis Index compared to the Modified 5-Item Frailty Index for predicting 30-day mortality after arthroplasty for femoral neck fractures needed evaluation.

Does the Risk Analysis Index (RAI) provide superior prediction of 30-day mortality compared to the Modified 5-Item Frailty Index (mFI-5) in patients undergoing arthroplasty for femoral neck fractures?

Population

14,913 patients 18 years or older undergoing HA or THA for FNFs

Comparison

Risk Analysis Index vs Modified 5-Item Frailty Index

Design

National database study

Follow-up

30 days

Key result

The Risk Analysis Index showed superior risk discrimination for 30-day mortality compared to the mFI-5 in patients undergoing total hip arthroplasty (C-statistic 0.84 vs 0.69) and hemiarthroplasty.

Authors

EPEthan ParisierVKVictor KoltenyukNGNithin Gupta

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Overview

May enhance preoperative mortality risk stratification in hip arthroplasty; hypothesis-generating and requires prospective validation before changing practice.

Key Points

  • To compare the accuracy of the Risk Analysis Index (RAI) versus the Modified 5-Item Frailty Index (mFI-5) in predicting 30-day mortality following hip arthroplasty for femoral neck fractures.
  • Retrospective cohort analysis of a national database from 2015 to 2020 including 14,913 patients aged ≥18 years undergoing hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fractures.
  • Multivariate logistic regressions and receiver operating characteristic curve analyses evaluated the predictive performance of RAI and mFI-5 for 30-day postoperative mortality.
  • Frailty significantly predicted increased 30-day mortality for HA (RAI OR: 1.46, 95% CI: 1.31 to 1.64; mFI-5 OR: 1.10, 95% CI: 1.08 to 1.12; P < 0.001 for both) and THA (RAI OR: 1.15, 95% CI: 1.106 to 1.190, P < 0.001; mFI-5 OR: 1.50, 95% CI: 1.167 to 1.923, P = 0.002).
  • RAI demonstrated superior discrimination compared to mFI-5 for THA (C-statistic: 0.84, 95% CI: 0.45 to 0.83 vs. C-statistic: 0.69, 95% CI: 0.68 to 0.71) and HA (C-statistic: 0.74, 95% CI: 0.73 to 0.75 vs. C-statistic: 0.62, 95% CI: 0.61 to 0.63).

Study Design

Type

Observational (n=14,913)

Multicenter

Yes

Structured PICO

Does the Risk Analysis Index (RAI) provide superior prediction of 30-day mortality compared to the Modified 5-Item Frailty Index (mFI-5) in patients undergoing arthroplasty for femoral neck fractures?

P
Population
14,913 patients aged 18 years or older undergoing hemiarthroplasty or total hip arthroplasty for femoral neck fractures, evaluated for 30-day mortality.
E
Exposure
Frailty assessment using the Risk Analysis Index (RAI)
C
Comparator
Frailty assessment using the Modified 5-Item Frailty Index (mFI-5)
O
Outcome
30-day mortalityhard clinical

Main Result

Odds Ratio: 1.46 (95% CI 1.31–1.64)

p-value: p=<0.001

The Risk Analysis Index (RAI) is a superior tool compared to the mFI-5 for predicting 30-day mortality in patients undergoing arthroplasty for femoral neck fractures.

Cite This Study

Parisier et al. (2026) conducted an observational in Femoral neck fractures (n=14,913). Risk Analysis Index (RAI) vs. Modified 5-Item Frailty Index (mFI-5) was evaluated on 30-day mortality (OR 1.46, 95% CI 1.31-1.64, p=<0.001). The Risk Analysis Index showed superior risk discrimination for 30-day mortality compared to the mFI-5 in patients undergoing total hip arthroplasty (C-statistic 0.84 vs 0.69) and hemiarthroplasty.

synapsesocial.com/papers/6a99352e636c6408cfa7d20chttps://doi.org/10.1016/j.arth.2026.08.055
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Risk Analysis Index for Estimation of 30-Day Postoperative Mortality in Hip Fractures2025 · 15 citations
  2. 2Comparative performance of the risk analysis index versus traditional frailty measures in predicting outcomes following revision total hip arthroplasty for mechanical prosthetic complications2026
  3. 3Utility of Revised Risk Analysis Index as a Predictor of Mortality and Morbidity in Orthopaedic Trauma2025 · 3 citations
  4. 4Comparison of the Risk Analysis Index and the Modified 5-Item Frailty Index in Predicting 30-Day Morbidity and Mortality After Occipitocervical Fusion2025 · 1 citations
  5. 5Risk Analysis Index Outperforms the Modified Frailty Index in Predicting Outcomes in Thyroidectomy and Parathyroidectomy2026 · 2 citations