Modifying the RAPT Score to Reflect Discharge Destination in Current Practice

Eric Cohen, MD; Daniel B.C. Reid, MD, MPH; Matthew Quinn, MD; Devin Walsh, MD; Jeremy Raducha, MD; Leigh Hubbard, RN, MHA; John Froehlich, MD

Arthroplasty Today (Feb 2021)

Modifying the RAPT Score to Reflect Discharge Destination in Current Practice

Eric Cohen, MD,
Daniel B.C. Reid, MD, MPH,
Matthew Quinn, MD,
Devin Walsh, MD,
Jeremy Raducha, MD,
Leigh Hubbard, RN, MHA,
John Froehlich, MD

Affiliations

Eric Cohen, MD: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
Daniel B.C. Reid, MD, MPH: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
Matthew Quinn, MD: Corresponding author. 593 Eddy Street, Providence, RI 02903, USA. Tel.: +1-401-369-2223.; Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
Devin Walsh, MD: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
Jeremy Raducha, MD: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
Leigh Hubbard, RN, MHA: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
John Froehlich, MD: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

Journal volume & issue: Vol. 7
pp. 17 – 21

Abstract

Read online

Background: The Risk Assessment Prediction Tool (RAPT) is a validated 6-question survey designed to predict primary total joint arthroplasty (TJA) patients’ discharge disposition. It is scored from 1 to 12 with patients stratified into high-, intermediate-, and low-risk groups. Given recent advancements in rapid-discharge protocols and increasing utilization of home services, the RAPT score may require modified scoring cutoffs. Methods: A retrospective chart review of all patients undergoing primary TJA at a single academic center over 14 months was performed. The RAPT score was implemented during the sixth month. Patients undergoing revision TJA, complex TJA, and TJA after resection of malignancy were excluded. Outcomes before and after RAPT implementation were analyzed with additional subanalysis investigating of post-RAPT data. Results: A total of 1264 patients (624 Pre-RAPT and 640 Post-RAPT) were evaluated. The post-RAPT group (245 total hip arthroplasty and 395 total knee arthroplasty) experienced significant decreases in mean hospital length of stay (2.22 days pre-RAPT to 1.82 days post-RAPT, P < .001) and the proportion of patients discharged to facility (21.8% pre-RAPT to 15.2% post-RAPT, P = .002). The modified system demonstrated the highest overall predictive accuracy at 92% and was found to be predictive of hospital length of stay. Conclusion: Owing to the recent trends favoring in-home services over rehab facility after discharge, previously published RAPT scoring cutoffs are inaccurate for modern practice. Using mRAPT cutoffs maximizes the number of patients for whom a discharge prediction can be made, while maintaining excellent predictive accuracy.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

About the journal

Abstract

Keywords