(0703) Predicting Disposition Following Free Flap Reconstruction Using the Risk Assessment and Prediction Tool

Introduction: The Risk Assessment and Prediction Tool (RAPT) is a 6-question instrument that has been validated and widely used to estimate the risk of requiring discharge to inpatient rehabilitation following hip or knee arthroplasty. Patients can answer the questions generating a score of 0-12 where a lower score indicates a higher risk of requiring extended rehabilitation. While designed for use in orthopedic surgery, the present study sought to assess the predictive capacity of the RAPT score in patients undergoing head and neck free flap reconstruction (HNFFR).

Methods: Patients undergoing HNFFR between 2021 and 2023 at a single tertiary care institution were retrospectively identified and included if a RAPT score was documented during a routine preoperative visit. They were classified into high risk (RAPT ≤ 9) and low risk (> 9) groups. A sub-analysis was performed to identify an intermediate range with a similar risk compared to more narrowly defined high and low risk groups. Demographics, surgical outcomes, postoperative destination, and length of stay (LOS) were assessed between the groups using chi squared. P-values of < 0.05 were considered statistically significant.

Results: In total, 75 patients were identified, with 46 classified as low risk and 29 as high risk. In the low risk group, 91% were discharged to home compared to 72% in the high risk group (p = 0.05). There were no significant differences observed in length of stay, 30-day readmissions, or flap failure between the two groups. Anterolateral thigh flaps were most common in both high and low risk groups (p = 0.6). The sub-analysis identified an intermediate score range of 7-9 with a rate of discharge to home of 74% that intentionally lacked statistical difference with the unchanged low risk group (p = 0.15) and a smaller high risk group (p = 0.72).

Conclusions: When utilized in a head and neck population the RAPT score has predictive value regarding discharge disposition and may be more practical than more complex indices. It may have utility in preoperative counseling, as well as in targeting intermediate risk patients with interventions to facilitate discharge to home.