Preoperative Prediction of Post-operative Needs after Spinal Tumor Surgery

Introduction: Spinal oncology care is challenging and resource intensive. The Penn SOaR program (Surgical Spinal Oncology, Medical Oncology, and Radiation Oncology) was initiated in 2014 to maximize care for this complex population. Post-operative patient comfort and resource utilization provide important opportunities for optimization. Unfortunately, there are few validated preoperative clinical tools to accurately predict postoperative healthcare needs. We aim to assess the utility of the externally developed Risk Assessment and Prediction Tool (RAPT) in predicting discharge disposition for patients undergoing spinal tumor surgery.

Methods: The RAPT questionnaire was administered preoperatively to consecutive patients undergoing spinal tumor resection from 2017 to 2024 at an academic medical center (n=384). RAPT assesses current walking capacity, use of gait aids, home support, and reliance on community support. Logistic regression analysis was used to associate the total RAPT score, and its subcomponents, with non-home discharge following surgery. Secondary outcomes included intraoperative complications, length of stay, 30- and 90-day Emergency Department (ED) visits, readmissions, reoperations, and mortality.

Results: A higher RAPT score was associated with significantly increased odds of home discharge (p < 0.0001, OR=1.484) and reduced risk of 30-day ED visits (p=0.0151, OR=0.834). There was no correlation between pre-operative RAPT score and intraoperative complications, length of stay, readmission, or reoperation. Improved baseline walking ability was able to predict home discharge (p=0.0001, OR=2.865), fewer 30-day ED visits (p=0.0422, OR=0.622), and reduced 90-day mortality (p=0.0008, OR= 0.456). Furthermore, preoperative ambulation without gait assistance was also correlated with increased home discharge (p=0.0001, OR=2.778) and decreased 30-day ED visits (p=0.0291, OR=0.622).

Conclusion : The preoperative RAPT score and its subcomponents are highly predictive and specific tools for discharge disposition in the spinal oncology population. Implementation of this simple questionnaire can help surgeons identify high-risk patients preoperatively and who may benefit from risk mitigation strategies to improve clinical outcomes.