Predictive Value of the Risk Assessment and Prediction Tool (RAPT) Score for Primary Hip and Knee Arthroplasty Patients: A Single-Center Study

Abstract

The Risk Assessment and Prediction Tool (RAPT) was developed to predict patient discharge destination for arthroplasty operations. However, since Enhanced Recovery After Surgery (ERAS) programs have been utilized in the UK, the RAPT score has not been validated for use. The aim of the current study was to evaluate the predictive validity of the RAPT score in an ERAS environment with short length of stay. Data were compiled from 545 patients receiving a primary elective total hip or total knee arthroplasty in a district general hospital over 12 months. RAPT scores, length of stay, and discharge destinations were recorded.Patients were classified as low, intermediate, or high risk as per their RAPT score. Length of stay was significantly different between groups (p = 0.008), with low-risk patients having shorter length of stay. However, RAPT scores did not predict discharge destination; the overall correct prediction was only 31.9%. Furthermore, the most likely discharge destination was directly home in ≤3 days in all groups (68.5%, 60.2%, and 40% for the low-, intermediate-, and high-risk groups, respectively).The RAPT score is not an adequate tool to predict the discharge disposition following primary total knee and hip replacement surgery in a UK hospital with a standardized modern ERAS program. Alternative predictive tools are required.

Preoperative Prediction and Risk Factor Identification of Hospital Length of Stay for Total Joint Arthroplasty Patients Using Machine Learning

“…Additionally, a lower RAPT score served as a significant predictive factor of an increased LOS; outpatients had the highest averaged RAPT score, and those with prolonged-stay patients had the lowest RAPT (outpatient: 10.0; short stay: 9.0; prolonged stay: 8.2; P < .001), which is consistent with existing studies [ 39 , 40 ]. Also, an unexpected admission or hospital transfer implied by the absence of RAPT was predictive of an increased LOS (outpatient: n = 21, 9.1%; short stay: n = 117, 13.0%; prolonged stay: n = 89, 33.3%; P < .001).…”

Use of The Risk Assessment and Prediction Tool to Predict Same-day Discharge After Primary Hip and Knee Arthroplasty

“…Alshawani et al found RAPT to be somewhat predictive of LOS, but not of discharge destination among a patient population in the United Kingdom. 16 Most recently, Oeding et al 17 found the RAPT score to be associated with inpatient versus outpatient status after TKA and THA. RAPT's ability to predict discharge deserves additional investigation, especially as fewer patients are being discharged to rehab facilities than in the past.…”

Trends in the Adoption of Outpatient Joint Arthroplasties and Patient Risk: A Retrospective Analysis of 2019 to 2021 Medicare Claims Data

“…More research has been done in the lower extremity arthroplasty patients. 3,5,6,[27][28][29][30][31][32][33] To date, at least 10 tools have been developed and published to help determine discharge disposition after TJA, but no one tool has been shown to be superior in ease of use and reliability. 27 One of the Graph showing the association between risk score and clinical outcomes among outpatients.…”