Matched Analysis of the Risk Assessment and Prediction Tool for Post-Operative Disposition Needs in a Spinal Oncology Population

Study Design Retrospective cohort study. Objectives As cancer survival improves, metastatic spinal cancer has become increasingly common worldwide. Given the high resource demands of spinal oncology care, tools to optimize perioperative planning are essential. The objective of the study was to assess the effectiveness of the Risk Assessment and Prediction Tool (RAPT) in predicting post-operative needs 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 associated with outcomes. 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; secondary outcomes were 30- and 90- day ED visits, readmissions, and reoperations. McNemar’s test was utilized for matched comparisons. Results A low RAPT score was significantly associated with non-home discharge (OR = 4.33 [1.23, 15.20], P = 0.02) and 30-day readmission (OR = 3.66 [1.02, 13.14], 0.03). 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 ER visits, reoperation, or mortality. Isolation of the RAPT walk score alone significantly predicted non-home discharge (OR = 2.8 [1.01, 7.78], P = 0.04). Conclusions When applied prospectively before spinal cancer surgery, the RAPT tool and its subcomponents effectively predict post-acute care needs. Pre-operative prediction of non-home discharge may help guide in-hospital resource allocation and post-acute care of spinal oncology patients.