57. RAPT score as a predictor of nonhome discharge after adult spinal deformity surgery

BACKGROUND CONTEXT Discharge location is an important step in the continuum of care for adults who undergo surgery for spinal deformity (ASD). Insight into which patients are at risk for nonhome discharge (acute rehabilitation and skilled nursing facility [SNF]) is essential for preoperative planning and counseling. The Risk Assessment and Prediction Tool (RAPT) score has been demonstrated to be a predictor of nonhome discharges following orthopedic and general surgery operations, but has not been evaluated in a cohort of ASD patients. PURPOSE To assess factors, including RAPT score, predictive of nonhome discharges following ASD operations. STUDY DESIGN/SETTING Retrospective cohort analysis. PATIENT SAMPLE Adult patients who underwent thoracolumbar instrumented fusions to the pelvis for ASD at a single institution (1/2019-1/2020) were retrospectively reviewed. OUTCOME MEASURES See Methods section below. METHODS Patient demographics, including preoperative RAPT metrics (scale 1-12), hospital length of stay (LOS), operative details (revision vs primary, anterior vs anterior-posterior, type of interbodies, 3-column osteotomy [3CO]), and complications (total, major, minor) were compared between patients discharged home and nonhome using Chi-squared statistics. Univariate and multivariate analyses were performed using linear regression to determine relative risk of nonhome discharge. Area under the receiver operating characteristic curve (AUROC) for RAPT score and nonhome discharge was also determined. RESULTS Ninety-nine patients (average age: 68±9 years; female-64; average RAPT score 8.6±2.2) were analyzed. Operations were characterized by the following: average number of levels fused 11±3, revisions 54%, anterior-posterior 70%, 3CO 23%. Average hospital LOS was 8.5±3.6 days. The majority of patients (75.8%) had nonhome discharges. Patients discharged to rehab/SNF had significantly lower total RAPT scores (8.3 v. 9.6; p=0.016), more advanced age (70±8 v. 63±11; p=0.0052), and higher Charlson comorbidity indices (CCI; 3.6±1.5 v. 2.5±1.7; p=0.0014) compared to home discharges. On univariate analysis, factors significantly associated with nonhome discharge were age (particularly >60 years) (RR 1.094; 95%CI 1.035-1.163; p=0.0024), higher CCI (RR 1.730; 95%CI 1.214-2.621; p=0.005), total # levels fused (RR 1.244; 95%CI 1.026-1.599; p=0.047), and lower RAPT scores (RR 0.710; 95%CI 0.528-0.914; p=0.014). A RAPT score CONCLUSIONS Nonhome discharges (rehab/SNF) after ASD operations are common. Of the 4 factors associated with nonhome discharges (elderly age, higher CCI, greater total number of levels fused, lower preoperative RAPT score), a RAPT score FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.