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RAPT score and preoperative factors to predict discharge location following adult spinal deformity surgery

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Abstract

Purpose

To assess factors, including RAPT score, predictive of non-home discharges following adult spinal deformity (ASD) operations.

Methods

Adults who underwent thoracolumbar instrumented fusions to the pelvis for ASD (1/2019–1/2020) were reviewed. Patient demographics, RAPT metrics, hospital length of stay (LOS), operative details, and complications were compared between patients discharged home and non-home. Univariate and multivariate analyses were performed using logistic regression to determine the relative risk of non-home discharge. Area Under the Receiver Operating Characteristic curve (AUROC) for RAPT score and non-home discharge was also determined.

Results

Ninety-nine patients (average age 68 ± 9 years; female-64; average RAPT 8.6 ± 2.2) were analyzed. Operations had the following characteristics: average # levels fused 11 ± 3, revisions 54%, anterior–posterior 70%, 3-column osteotomies 23%. Average LOS was 8.5 ± 3.6 days. The majority of patients (75.8%) had non-home discharges. Non-home discharges had significantly lower RAPT scores (8.3 vs. 9.6; p = 0.02), more advanced age (70 vs. 63 years; p = 0.01), and higher Charlson Comorbidity Index (CCI) scores (3.6 vs. 2.5; p < 0.01) compared to home discharges. On univariate analysis, factors significantly associated with non-home discharge were older age [relative risk (RR) 1.09, p < 0.01], higher CCI (RR 1.73, p = 0.01), total # levels fused (RR 1.24, p = 0.04), and lower RAPT scores (RR 0.71, p = 0.01). RAPT score < 8 was most predictive of non-home discharge (RR 4.87, p = 0.04). An AUROC relating RAPT scores and non-home discharge was 0.7.

Conclusions

Non-home discharges after ASD operations are common. Of the four factors associated with non-home discharges (elderly age, higher CCI, total number of levels fused, RAPT score), a RAPT score < 8 was most predictive. The RAPT score holds promising utility for pre-operative patient counseling and discharge planning for adults undergoing operations for spinal deformity.

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Funding

No funding was obtained for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California - San Francisco, 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA

    Daniel Cummins, Stephen Georgiou, Shane Burch, Bobby Tay, Sigurd H. Berven, Vedat Deviren & Alekos A. Theologis

  2. Department of Neurological Surgery, UCSF, San Francisco, CA, USA

    Christopher P. Ames & Aaron J. Clark

Authors
  1. Daniel Cummins
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  2. Stephen Georgiou
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  3. Shane Burch
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  4. Bobby Tay
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  5. Sigurd H. Berven
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  6. Christopher P. Ames
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  7. Vedat Deviren
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  8. Aaron J. Clark
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  9. Alekos A. Theologis
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Contributions

Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work: DC, SG, SB, TB, SB. Drafted the work or revised it critically for important intellectual content: DC, SG, SB, TB, SB. Approved the version to be published: DC, SG, SB, TB, SB. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: DC, SG, SB, TB, SB, CA, VD, AC, AT.

Corresponding author

Correspondence to Alekos A. Theologis.

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Cummins, D., Georgiou, S., Burch, S. et al. RAPT score and preoperative factors to predict discharge location following adult spinal deformity surgery. Spine Deform 10, 639–646 (2022). https://doi.org/10.1007/s43390-021-00439-8

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  • DOI: https://doi.org/10.1007/s43390-021-00439-8

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