INTRODUCTION: Spinal oncology care is challenging and resource-intensive. Unfortunately, there are few validated preoperative clinical tools to accurately predict postoperative healthcare needs. The Risk Assessment and Prediction Tool (RAPT) assesses current walking capacity, use of gait aids, home support, and reliance on community support. We aim to assess the utility of the RAPT in predicting discharge disposition for patients undergoing spinal tumor surgery. METHODS: RAPT was administered preoperatively to consecutive patients (n = 389) undergoing spinal tumor resection from 2017 to 2024 at an academic medical center. Logistic regression analysis was used to associate the total RAPT score, and its subcomponents, with non-home discharge. 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 preoperative RAPT score and intraoperative complications, length of stay, readmission, or reoperation. Improved RAPT subscore for 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: 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 design risk mitigation strategies.