RAI for postoperative outcomes following anterior cervical spine surgery had superior predictive ability when compared with the mFI-5, with superior discrimination for mortality, major complications, and non-home discharge. These findings suggest that RAI has the promise for superior preoperative risk stratification for clinicians, potentially facilitating superior identification among high-risk patients, superior perioperative management tailoring, and superior resource allocation. Surgical planning with RAI would potentially facilitate improved patient counseling, support for shared decision-making, and potentially reduced postoperative adverse event rates among the medically complex and the aged.