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Introduction Frailty and nutritional status are increasingly recognized as important predictors of perioperative outcomes and are commonly used for preoperative risk stratification. This study evaluates the predictive utility of five risk metrics [American College of Surgeons Surgical Risk Calculator (ACS SRC), preoperative serum albumin, Risk Analysis Index (RAI), Geriatric Nutritional Risk Index (GNRI), and Modified Frailty Index-5 (mFI-5)] for postoperative complications following open surgery for aneurysmal subarachnoid hemorrhage (SAH).Methods We analyzed data from the ACS National Surgical Quality Improvement Program (ACSNSQIP) including adults (≥18years) who underwent open neurosurgical procedures between 2017 and 2022 for aneurysmal SAH. Adjusted odds ratios (aORs) were estimated through multivariable logistic regression models. Discriminative performance was evaluated using receiver operating characteristic (ROC) analysis with C-statistics derived from the DeLong test.Results After applying specialty and Current Procedural Terminology (CPT) code filters, 426 patients who underwent open repair for aneurysmal SAH were included in the analysis. The ACS-SRC demonstrated the highest predictive accuracy for most outcomes, with C-statistics of 0.78 (95% CI: 0.72-0.84) for 30-day mortality, 0.72 (95% CI: 0.67-0.77) for overall complications, and 0.70 (95% CI: 0.66-0.75) for major complications. Serum albumin and GNRI demonstrated moderate predictive performance and were frequently the second-best performing metrics across several complication domains. Serum albumin showed strong discrimination for superficial wound site infection (AUC 0.615) and myocardial infarction (AUC 0.730). Similarly, GNRI demonstrated favorable predictive ability for myocardial infarction (AUC 0.834) and clostridium difficile infection (AUC 0.734). RAI and mFI-5 showed weaker discrimation in this study and were majorly outperformed by the other frailty metrics. Multivariate regression analysis revealed higher RAI, mFI-5, and ACS-SRC scores, as well as lower serum albumin levels, were independent predictors of increased 30-day mortality, overall complications, and major complications.Conclusion The ACS SRC demonstrated the strongest predictive performance across outcome domains in patients undergoing open repair for aneurysmal SAH. However, the ACS SRC was developed and validated using the same NSQIP dataset from which this cohort was derived, which may inherently favor its performance. Among the remaining metrics, preoperative serum albumin showed consistent secondary predictive value and may serve as a pragmatic alternative when calculator inputs are unavailable or incomplete. These findings highlight the role of simple nutritional and frailty markers in predicting particular postoperative outcomes. However, the factors influencing the choice of open surgery over endovascular therapy may confound these associations, hence, these findings would not generalize to patients treated with endovascular approaches.Disclosures K. Darko: None. N. Darko: None. D. Anglade: None. M. Farid: None.Abstract E-118 Figure 1