Table 1. Components, Definitions, and Operationalizations Across the Four Risk Analysis Index (RAI) Variants.
| Definition | RAI-C | RAI-A | RAI-VQI | RAI-ICD | |
|---|---|---|---|---|---|
| Age | Chronological age in years. | Patient’s stated age or age recorded in electronic record; clinicians should choose the most accurate integer value. | AGE | AGE | — |
| Sex | Biological sex as a binary construct, not to be confused or conflated with gender identity or legal sex; clinicians are encouraged to use clinical judgment in ascertaining this variable respectfully in cases in which gender identity or legal sex are different than biological sex. | Patient’s reported sex or sex recorded in the electronic record; clinicians should choose the most accurate. (Response values: “male” or “female.”) | SEX | GENDER | — |
| Cancer | Intended to indicate any active cancer not definitively in remission. Originally operationalized in VASQIP as any neaodjuvent chemo- or radiotherapy or disseminated disease, subsequent work aimed at maximizing sensitivity focused on any cancer not in remission. (See Estock et al.13 for exploration of how best to interpret the cancer variable.) | In the past 5 years, have you been diagnosed with or treated for cancer? | DISCANCER or RADIO or CHEMO | — | C77–C79 |
| Unintentional Weight Loss | Operationalized as more than 10 pounds in past 3 months. | In the past 3 months, have you lost 10 pounds or more without trying? (Yes/No) | WTLOSS | WTKG and HTCM and HTIN | R63.4, R63.6, R64, R62.7 |
| Poor Appetite | Any patient- or caregiver-reported decline in appetite. | Is your appetite currently poor? (Yes/No) | WTLOSS | — | R63.0, R63.39, R63.8 |
| Renal Failure | Operationalized to include not just renal failure and dialysis but also renal insufficiency, although no specific threshold of glomerular filtration rate or creatinine has been established. Patient facing survey operationalized as any visit to a “kidney doctor” for a condition other than renal calculi. | Have you ever seen a nephrologist (kidney doctor) or have a history of kidney problems? (Yes/No) If yes, was this for kidney stones or another problem? (Response values: “Kidney Stones,” “Other,” “Both kidney stones and another problem.”) | RENALFAIL or DIALYSIS | PREOP_CREAT or PREOP_DIALYSIS or DIALYSIS | I12.0, I13.11, I13.2, N18.4 - N18.6, Z49, Z99.2 |
| Congestive Heart Failure | Any reported history of heart failure regardless of AHA classification, especially if there is associated deficit in functional performance. | Do you have chronic (long-term) congestive heart failure (CHF)? (Yes/No) | HXCHF | PRIOR_CHF | I50 |
| Dyspnea | Any reported shortness of breath with minimal exertion. May also include any use of supplemental oxygen. | Do you have shortness of breath while resting or with minimal activity? (Yes/No) Prompt: “Do you have trouble catching your breath when you are resting or doing minimal activities (for example, walking to the bathroom or mailbox”)? | DYSPNEA | COPD | J96.1, R06.0, Z99.81 |
| Other Living Setting | Any residence other than independence. Duration and location are not required for scoring but typically ascertained to inform the clinician. | Do you live in a nursing home, skilled nursing facility, or another assisted living environment? (Yes/No) If yes, where do you live? (Response values: “nursing home,” “skilled nursing facility,” “assisted living.”) If yes, “When did you begin living in there?” (Response values: “Less than 3 months ago,” “3 months to 1 year ago,” “Greater than 1 year ago.”) | TRANST | LIVING STATUS or TRANSFER or PREOP_AMBUL | — |
| Cognitive Decline | Any observable and chronic cognitive decline or dementia. Clinician or caregiver opinion is often preferred, given the challenges of self-report. | During the last 3 months, has it become more difficult for you to remember things or organize your thoughts? | IMPSENS or COMA or CVANEURO | — | F01.50, F01.51, F02.80, F02.81, F03.9, F03.91, G30, G31, R41.81 |
| Functional Status and Activities of Daily Living * | Functional Status: Totally Dependent | — | FNSTATUS = 3, totally dependent | FUNCSTATUS | G12, G80.0– G80.2, G81, G82.21, G82.50– G82.54, R53.2, Z74.01, Z74.09, Z74.3, Z99.3, Z99.89 |
| Functional Status: Partially Dependent | — | FNSTATUS = 2, partially dependent | FUNCSTATUS | G82.22, G83.1, G83.2, R26.2, R26.8, R26.9, R53.1, R54, Z73.6, Z74.1, Z74.2, Z91.81 | |
| Functional Status: Independent | — | FNSTATUS = 0, independent | FUNCSTATUS | — | |
| Mobility | Can get around without any help. (Score: 0) Needs help from a cane, walker, or scooter. (Score: 1) Needs help from others to get around the house or neighborhood. (Score: 2) Needs help getting in or out of a chair. (Score: 3) Totally dependent on others to get around. (Score: 4) |
— | — | — | |
| Eating | Can plan and prepare own meals. Needs help planning meals. Needs help preparing meals. Needs help eating meals. Totally dependent on others to eat meals. |
FNSTATUS | — | — | |
| Toileting | Can use the toilet without help. Needs help getting to or from the toilet. Needs help to use toilet paper. Cannot use a standard toilet, but with help can use a bedpan/urinal. Totally dependent on others to manage toileting. |
FNSTATUS | — | — | |
| Personal Hygiene | Can shower or bathe without prompting or help. Can shower or bathe without help when prompted. Needs help preparing the tub or shower. Needs some help with some elements of washing. Totally dependent on others to shower or bathe. |
FNSTATUS | — | — |
C, clinical; A, administrative; VQI, Vascular Quality Initiative; ICD, International Classification of Diseases; VASQIP, US Department of Veterans Affairs Surgical Quality Improvement Program; AHA, American Heart Association; ACS NSQIP, American College of Surgeons National Surgical Quality Improvement Program.
*
Ideally conceptualized as activities of daily living, but approximated in VASQIP, ACS NSQIP, VQI, and ICD-10 with variables that indicate independent, partially dependent, or totally dependent functional status.