Introduction: Spinal cancer is increasingly common and associated with high resource utilization. Efforts to improve care and reduce resource consumption are important. The Penn SOaR program (Surgical Spinal Oncology, Medical Oncology, and Radiation Oncology) was initiated in 2014 to optimize complex care for this population. The Risk Assessment and Prediction Tool (RAPT), a six-question survey previously developed for patients undergoing orthopedic joint replacement, now effectively predicts post-surgical care needs in several populations. The objective of the study was to assess the effectiveness of RAPT in patients undergoing surgery for spinal tumors.
Methods: Consecutive patients (n=384) undergoing spinal oncology surgery were enrolled and prospectively assessed with RAPT. Coarsened exact matching (CEM) was used to retrospectively isolate risk factors and assess the utility of RAPT. Enrolled patients with a low RAPT score (≤9, n=44) were exact matched against high-scoring patients (10-12, n=44). The primary outcome of interest was post-acute care disposition; the secondary outcomes were ER visits, readmissions, and reoperations (30D and 90D.) McNemar’s test (a non-parametric test for paired dichotomous data sets) was utilized to compare outcomes of interest.
Results: A low RAPT score was significantly associated with non-home discharge (OR 4.33 [1.23, 15.20], p=0.02). Among low-scoring patients, 31.8% required post-acute care (while only 11.3% of high-scoring patients required post-acute care). A low RAPT score was not associated with readmission, ER visits, or reoperation. Isolation of the RAPT Walk score alone significantly predicted non-home discharge (OR 2.8 [1.01, 7.78], p=0.04).
Conclusion : When applied prospectively before spinal cancer surgery, the RAPT tool and its subcomponents effectively predict post-acute care needs. Preoperative prediction of non-home discharge may help guide in-hospital resource allocation and post-acute care of spinal oncology patients.
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