The Risk Assessment and Prediction Tool Is Less Accurate in Extended Length of Stay Patients Following Total Joint Arthroplasty

Cizmic, Zlatan; Feng, James E.; Anoushiravani, Afshin A.; Borzio, Robert W.; Schwarzkopf, Ran; Slover, James

doi:10.1016/j.arth.2018.11.008

Cited by 18 publications

(13 citation statements)

References 10 publications

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“…Similar results were reported by Dibra et al, who validated the predictive value of the score in terms of discharge destination; however, they recommended modifying the score as the predictive expectation increased the predictive value [6,7] . On the contrary , and in the US as well Cizmic et al look mainly into the patient with extended stay over 3 days and found that the score is less predictive regarding discharge destination in those cohort , which probably coincide though partially with our study [8]. Sisac et al highlighted the positive effect of preoperative education that is targeted at high-risk patients in which the LOS was reduced, which affects the predictive value of the score, by shortening LOS in high-risk individual; this has been demonstrated in our study as well, as the score was already recorded preoperatively in the educational sessions before the procedure , i.e., the joint school [13].…”

Section: Discussionsupporting

confidence: 77%

“…The reports from the US were contradicting, where Dibra et al [6] and Hansen et al [7] found the score reliable for discharge planning and to identify the need for extended postoperative rehabilitation for low score patients. On the other hand, in the US as well, Cizmic et al [8] revealed low predictive accuracy for discharge destination for patients with extended LOS despite good prediction for the LOS itself. This score was also reliable in Asia, where Tan et al found the score reliable for knee arthroplasty patients to determine the LOS and the discharge destination [9].…”

Section: Introductionmentioning

confidence: 99%

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

Alshahwani¹,

Dungey²,

Lillie³

et al. 2021

Cureus

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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.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

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

Alshahwani¹,

Dungey²,

Lillie³

et al. 2021

Cureus

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“…This resulted in large percentage of patients for whom discharge planning could not be predicted as well as poor predictive accuracy for patients defined as high risk. Previous RAPT studies have reported poor predictive accuracy for intermediate risk patients; however, poor predictive accuracy among high-risk cohorts has not yet been reported [1,9,10]. Failure of prior published scoring cutoffs is likely secondary to a general shift toward home discharge among patients overall.…”

Section: Discussionmentioning

confidence: 91%

“…Postarthroplasty care is one area of focus in the effort to lower costs through decreased hospital length of stay as well and appropriate discharge home of patients. In response to the increased costs associated with discharge to skilled care facilities, many institutions have implemented clinical care pathways with tremendous success through reductions in length of hospital stay, usage of postacute care services, and rates of readmission [1][2][3]9,10,15]. Appropriate identification and risk stratification of each patient is imperative as unexpected deviations may lead to increased financial expenditures, unnecessary medical waste, and poor patient satisfaction [15].…”

Section: Discussionmentioning

confidence: 99%

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Modifying the RAPT Score to Reflect Discharge Destination in Current Practice

et al. 2021

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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 rapiddischarge 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 ¼ .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.

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Clinical Study on the Screening of Lower Extremity Deep Venous Thrombosis by D-Dimer Combined with RAPT Score Among Orthopedic Trauma Patients

Zhao

Ali

Sang

2020

IJOO

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Background Among the causes of mortality in patients with lower extremity fracture following surgery, lower extremity deep venous thrombosis (DVT) is a leading one. To lower the morbidity and mortality, early screening and preventive anticoagulation therapy are essential in clinical study. Common screening methods, including risk prediction tools, imaging tests and D-dimer test, had various drawbacks. The study aimed to establish a new method, that is, D-dimer combined with Risk Assessment and Predictor Tool (RAPT) score, for screening the lower extremity DVT among patients with lower extremity fracture and evaluate its clinical value. Materials and MethodsThe RAPT score, plasma D-dimer and lower extremity venous ultrasonography examination reports were collected from Department of Emergency Surgery & Orthopaedic Surgery from July 2019 to December 2019, and the data were analyzed retrospectively. Regarding the lower extremity venous ultrasonography examination report as the "gold standard" to determine whether DVT exists, the sensitivity, specificity and area under the curve (AUC) of RAPT score alone, plasma D-dimer alone and combination of them in screening lower extremity DVT were analyzed and evaluated. Results 197 patients were enrolled in the study. There were significant differences in D-dimer level and RAPT score between DVT group and non-DVT group (P < 0.01). The sensitivity, specificity and AUC of RAPT score and D-dimer in screening lower extremity DVT were 78.12%, 56.44%, 0.723 and 97.71%, 25.74%, 0.803, respectively. The optimal diagnostic value of D-dimer decided by Youden's index was 1.125 μg/ml. The sensitivity and specificity of the method by combining RAPT score with this new D-dimer threshold were 96.88% and 42.57%, respectively, and AUC was 0.812. Conclusion Higher diagnostic accuracy could be achieved by combining RAPT score with new D-dimer threshold. This novel diagnostic method is potential in the clinical diagnosis of DVT among orthopedic trauma patients.

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The Risk Assessment and Prediction Tool Is Less Accurate in Extended Length of Stay Patients Following Total Joint Arthroplasty

Cited by 18 publications

References 10 publications

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

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

Modifying the RAPT Score to Reflect Discharge Destination in Current Practice

Clinical Study on the Screening of Lower Extremity Deep Venous Thrombosis by D-Dimer Combined with RAPT Score Among Orthopedic Trauma Patients

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