INTRODUCTION AND OBJECTIVES The Risk Assessment Index (RAI) frailty scoring system, developed in an all-male veteran cohort, has recently undergone revision and validation using a general surgical sample from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We set forth to investigate the association between RAI-rev scores and lower extremity bypass outcomes by gender in the NSQIP database. METHODS All elective cases recorded from 2015-2019 in the NSQIP Targeted Lower Extremity Open database were paired with the Participant User File using Case IDs. Cohorts were defined by EMR-recorded gender. Top quartile postoperative length of stay was defined as extended. Aggregate cohort demographics, perioperative factors, and 30-day outcomes were compared using unpaired t-test and Fisher's exact test. Adjusted odds-ratios for outcomes were generated with a multivariate binary logistic regression model utilizing prior ipsilateral bypass versus percutaneous intervention, graft utilization, dirty/infected wound, smoking, hypertension, diabetes, and steroid use as covariates. Calculated RAI-rev scores <25 were defined as the non-frail reference range. RESULTS 8,155 bypass cases were recorded in NSQIP from 2015-2019 including 2,498 (31%) performed in women who had slightly lower RAI-rev scores on average (22.1 ± 5.8 vs 24.2 ±5.1; p=0.0001). While univariate trends suggested increasing incidence for most outcomes across both represented genders, there were more non-significant aOR for women than men (Table). Analysis of 4 patients with RAI-rev scores >45 resulted in no significant aOR. CONCLUSIONS Our study is the first to find that outcomes other than mortality are significantly predicted by RAI-rev score ranges in lower extremity bypass. Stratification of aOR by gender suggests that additional validation of frailty scores may be warranted as these systems gain wider use. The Risk Assessment Index (RAI) frailty scoring system, developed in an all-male veteran cohort, has recently undergone revision and validation using a general surgical sample from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We set forth to investigate the association between RAI-rev scores and lower extremity bypass outcomes by gender in the NSQIP database. All elective cases recorded from 2015-2019 in the NSQIP Targeted Lower Extremity Open database were paired with the Participant User File using Case IDs. Cohorts were defined by EMR-recorded gender. Top quartile postoperative length of stay was defined as extended. Aggregate cohort demographics, perioperative factors, and 30-day outcomes were compared using unpaired t-test and Fisher's exact test. Adjusted odds-ratios for outcomes were generated with a multivariate binary logistic regression model utilizing prior ipsilateral bypass versus percutaneous intervention, graft utilization, dirty/infected wound, smoking, hypertension, diabetes, and steroid use as covariates. Calculated RAI-rev scores <25 were defined as the non-frail reference range. 8,155 bypass cases were recorded in NSQIP from 2015-2019 including 2,498 (31%) performed in women who had slightly lower RAI-rev scores on average (22.1 ± 5.8 vs 24.2 ±5.1; p=0.0001). While univariate trends suggested increasing incidence for most outcomes across both represented genders, there were more non-significant aOR for women than men (Table). Analysis of 4 patients with RAI-rev scores >45 resulted in no significant aOR. Our study is the first to find that outcomes other than mortality are significantly predicted by RAI-rev score ranges in lower extremity bypass. Stratification of aOR by gender suggests that additional validation of frailty scores may be warranted as these systems gain wider use.