Introduction: Previous studies have attempted to validate the risk assessment and prediction tool (RAPT) in primary total hip arthroplasty (THA) patients. The purpose of this study was to: (1) identify patients who had an extended length of stay (LOS) following THA; and (2) compare the accuracy of 2 previously validated RAPT models.
Methods: We retrospectively reviewed all primary THA patients from 2014 to 2021 who had a completed RAPT score. Youden's J computational analysis was used to determine the LOS where facility discharge was statistically more likely. Based on the cut-offs proposed by Oldmeadow and Dibra, patients were separated into high- (O: 1 to 5 versus D: 1 to 3), medium- (O: 6 to 9 versus D: 4 to 7), and low- (O: 10 to 12 versus D: 8 to 12) risk groups.
Results: We determined that an LOS of greater than 2 days resulted in a higher chance of facility discharge. In these patients (n = 717), the overall predictive accuracy (PA) of the RAPT was 79.8%. The Dibra model had a higher PA in the high-risk group (D: 68.2 versus O: 61.2% facility discharge). The Oldmeadow model had a higher PA in the medium-risk (O: 78.7 versus D: 61.4% home discharge) and low-risk (O: 97.0 versus D. 92.5% home discharge) groups.
Conclusions: As institutions continue to optimize LOS, the RAPT may need to be defined in the context of a patient's hospital stay. In patients requiring an LOS of greater than 2 days, the originally established RAPT cut-offs may be more accurate in predicting discharge disposition.
Level Of Evidence: III Retrospective Cohort Study.
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