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

Awf A Alshahwani,Maurice Dungey,Christos Plakogiannis,Steve Krikler,Christopher Lillie

doi:10.7759/cureus.14112

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.

Highlights

Hip and knee arthroplasties are among the most commonly performed orthopedic operations, and their number increases every year in the UK [1]
Since Enhanced Recovery After Surgery (ERAS) programs have been utilized in the UK, the Risk Assessment and Prediction Tool (RAPT) score has not been validated for use
All primary TKA or THA patients were invited to a joint school prior to their operation

Summary

Introduction

Hip and knee arthroplasties are among the most commonly performed orthopedic operations, and their number increases every year in the UK [1]. The score has been validated in several countries It has been utilized in Europe by Dauty et al and Coudeyre et al, in which both revealed strong predictive value of the score regarding the LOS and the discharge destination [4,5]. 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 reliable in Asia, where Tan et al found the score reliable for knee arthroplasty patients to determine the LOS and the discharge destination [9]

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