The utility of the Risk Assessment and Prediction Tool in predicting discharge disposition, length of stay, and readmissions in patients undergoing transforaminal lumbar interbody fusion
Journal of Neurosurgery Spine · 12 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Spine surgeons are increasingly asked to predict discharge needs preoperatively for bundled-payment and value-based care purposes, and this paper tests whether a tool borrowed from arthroplasty actually works for TLIF patients.
The evidence
This retrospective cohort study of 116 patients undergoing open TLIF looked at whether the preoperative RAPT score (a tool originally designed for joint replacement) predicts discharge destination, length of stay, and 30-day readmission. Higher RAPT scores were associated with greater odds of home discharge (adjusted OR 2.17) and shorter length of stay (adjusted β −0.39 days), but RAPT was not associated with 30-day readmission, and its discrimination for facility discharge was only moderate (AUC 0.709).
Home discharge: Odds ratio 2.17 (95% CI 1.24 to 3.8; RAPT). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Retrospective cohort
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot applicable
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If RAPT modestly predicts home discharge after TLIF but not readmission, how should surgeons weigh its score against other clinical judgement when counselling patients preoperatively?
2.Given the wide, imprecise cutoffs found here (9.5 vs 8.5 vs 10.5), should institutions adopt RAPT for TLIF discharge planning now, or wait for validation in larger multicentre cohorts?
Original publication title
The utility of the Risk Assessment and Prediction Tool in predicting discharge disposition, length of stay, and readmissions in patients undergoing transforaminal lumbar interbody fusion