Does the Veterans Affairs Risk Analysis Index Overestimate Frailty in Patients With Localized Prostate Cancer?

[INTRODUCTION] The Veterans Affairs Health System recently implemented the Risk Analysis Index (RAI) to assess frailty before surgery. Elevated RAI scores trigger a surgical pause and geriatric consultation to reduce short-term morbidity. However, any cancer diagnosis, including localized prostate cancer (PCa), increases RAI, potentially overstating frailty in otherwise healthy patients. We hypothesized that low-risk or intermediate-risk PCa does not correlate with 30-day morbidity and mortality predicted by RAI.

[METHODS] We retrospectively reviewed patients with low-risk or intermediate-risk PCa who underwent radical prostatectomy at a single institution over 5 years. RAI-administrative (RAI-A) scores were calculated with and without including PCa. Thirty-day postoperative complications and mortality were compared with rates predicted by RAI-A using data from the original Veterans Affairs Surgical Quality Improvement Program study.

[RESULTS] Among 130 patients (median age 61), 53.4% had favorable intermediate-risk, 41.2% unfavorable intermediate-risk, and 5.3% low-risk PCa. Mean RAI-A excluding PCa was 8.58, and including PCa it was 24.95. Corresponding Veterans Affairs Surgical Quality Improvement Program-predicted complication rates were 4.6% (2.5% grade IV-V) and 11.2% (5.6% grade IV-V). In our cohort, 6 patients (4.6%) experienced complications, none grade IV-V.

[CONCLUSIONS] Including localized PCa in RAI-A calculations overestimates frailty and predicted morbidity. Excluding the PCa diagnosis may better reflect surgical risk in low-risk or intermediate-risk patients, preventing unnecessary delays in treatment.