BACKGROUND: Bundled care payments are increasingly being explored for 
neurosurgical interventions. In this setting, skilled nursing facility (SNF) is 
less desirable from a cost perspective than discharge to home, underscoring the 
need for better preoperative prediction of postoperative disposition.
OBJECTIVE: To assess the capability of the Risk Assessment and Prediction Tool 
(RAPT) and other preoperative variables to determine expected disposition prior 
to surgery in a heterogeneous neurosurgical cohort, through observational study.
METHODS: Patients aged 50 yr or more undergoing elective neurosurgery were 
enrolled from June 2016 to February 2017 (n = 623). Logistic regression was used 
to identify preoperative characteristics predictive of discharge disposition. 
Results from multivariate analysis were used to create novel grading scales for 
the prediction of discharge disposition that were subsequently compared to the 
RAPT Score using Receiver Operating Characteristic analysis.
RESULTS: Higher RAPT Score significantly predicted home disposition (P < .001). 
Age 65 and greater, dichotomized RAPT walk score, and spinal surgery below L2 
were independent predictors of SNF discharge in multivariate analysis. A grading 
scale utilizing these variables had superior discriminatory power between SNF 
and home/rehab discharge when compared with RAPT score alone (P = .004).
CONCLUSION: Our analysis identified age, lower lumbar/lumbosacral surgery, and 
RAPT walk score as independent predictors of discharge to SNF, and demonstrated 
superior predictive power compared with the total RAPT Score when combined in a 
novel grading scale. These tools may identify patients who may benefit from 
expedited discharge to subacute care facilities and decrease inpatient hospital 
resource utilization following surgery.