• Ian Berger, Matthew Piazza, Nikhil Sharma, Gregory Glauser, Benjamin Osiemo, Scott D McClintock, Lee John Y K JYK Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania., James M Schuster, Zarina Ali, and Neil R Malhotra.
• Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
• Neurosurgery. 2019 Nov 1; 85 (5): E902-E909.

BackgroundBundled care payment models are becoming more prevalent in neurosurgery. Such systems place the cost of postsurgical facilities in the hands of the discharging health system. Opportunity exists to leverage prediction tools for discharge disposition by identifying patients who will not benefit from prolonged hospitalization and facilitating discharge to post-acute care facilities.ObjectiveTo validate the use of the Risk Assessment and Predictive Tool (RAPT) along with other clinical variables to predict discharge disposition in a cervical spine surgery population.MethodsPatients undergoing cervical spine surgery at our institution from June 2016 to February 2017 and over 50 yr old had demographic, surgical, and RAPT variables collected. Multivariable regression analyzed each variable's ability to predict discharge disposition. Backward selection was used to create a binomial model to predict discharge disposition.ResultsA total of 263 patients were included in the study. Lower RAPT score, RAPT walk subcomponent, older age, and a posterior approach predicted discharge to a post-acute care facility compared to home. Lower RAPT also predicted an increased risk of readmission. RAPT score combined with age increased the predictive capability of discharge disposition to home vs skilled nursing facility or acute rehabilitation compared to RAPT alone (P < .001).ConclusionRAPT score combined with age is a useful tool in the cervical spine surgery population to predict postdischarge needs. This tool may be used to start early discharge planning in patients who are predicted to require post-acute care facilities. Such strategies may reduce postoperative utilization of inpatient resources.Copyright © 2019 by the Congress of Neurological Surgeons.

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