Accuracy of RAPT Score in Predicting Discharge Disposition in Patients Undergoing Spine Surgery Within an Enhanced Recovery After Surgery Program.

Abstract

This is a retrospective cohort study. The primary objective was to determine the accuracy of the Risk Assessment and Prediction Tool (RAPT) score-based discharge disposition prediction among patients undergoing spine surgery within an Enha Recovery After Surgery (ERAS) program. The secondary objective was to determine if using RAPT to initiate preoperative referrals to home services expedited care. The RAPT score has been applied to spine surgery patients but has not been validated among participants in an ERAS program. All patients undergoing elective spine surgery within an ERAS program over a 1-year period received a preoperative social work evaluation incorporating the generation of RAPT score. Patients predicted to be discharged home with services received a preoperative referral for home services. The predicted versus actual discharge destination was compared, and the association of preoperative home services referral with the timing of home services initiation was assessed. Four hundred eight patients received a preoperative social work evaluation with RAPT score calculation. Two hundred seven (50.7%) patients had an accurately predicted postoperative discharge disposition based on RAPT score. Among the patients who received home services following discharge, the mean time to receipt of home services was shorter among patients who had a correct discharge disposition prediction compared with patients who had an incorrect prediction, but this difference was not statistically significant [31.3 (SD: 15.6) vs. 42.0 h (SD: 44.2), P=0.24]. This study supports the feasibility of integrating RAPT score calculation into a preoperative social work evaluation. However, the traditional tiers of RAPT scores had limited accuracy in predicting discharge disposition in this cohort of patients undergoing spine surgery within an ERAS program. Level III.