All Pre-Op Patients Should Be Evaluated for Fall History

All patients about to undergo surgery should be preoperatively evaluated for fall history, according to a new op-ed in the journal EBioMedcine.

The conclusion comes from the results of a new study, also published in EBioMedicine, that finds that pre-op falls are a risk factor for post-op falls, as well as post-surgical complications.

Though postoperative falls are more common than falls in the general population, they're understudied, researchers from the Washington University School of Medicine and the University of Michigan wrote in the study, published online Aug. 25. To look at this patient population, the researchers followed 7,982 pre-surgical patients prospectively. Each patient reported whether he or she had a history of falling in the six months prior to surgery. The researchers then gathered 30-day follow-up data from 7,902 patients, and 1-year follow-up data from 2,320 patients.

While the general population fall rate is 81 per 100 person-years, the researchers found, the pre-op fall rate in the sample was 120 per 100 person-years. The rate rose to 175 per 100 person-years during postoperative hospitalization, and was 140 at the 30-day follow-up. The rate remained elevated at 97 per 100 person-years between 30 days and 1 year after surgery.

Neurosurgery patients had the highest fall rate at all time points (from 273 at baseline to 162 one year post-op).

Severe falls were not rare. Forty-five percent of those who experienced a post-op fall at the 30-day follow-up had been injured, 18 percent seriously. Sixty-six percent of patients reported an injury from a fall at after one year, and 27 percent of those who said they'd fallen had been severely injured.

Important for preventative efforts, the researchers found only two risk factors for post-op falls: low physical activity capability and preoperative falls. Even one fall in the six months before surgery predicted falls postoperatively (adjusted OR 2.3, p<0.001). Two or three falls prior to surgery raised the risk of a post-op fall even more (adjusted OR 3.4 and 5.5, respectively, p<0.0001).

Preoperative falls were also associated with a greater likelihood of functional decline at 30 days post-op (adjusted O.R. 1.2 for 1 pre-op fall, 2.4 for 2 or 3 pre-op falls, p<0.001), the researchers found. Pre-op falls were also a risk factor for in-hospital complications after surgery. (OR 2.0, 99 percent C.I., 1.5-2.7). The link between falls and function was not surprising, the researchers wrote, but the association was stronger than expected. There was also no association or interaction with age and the outcomes; the results held across the entire age range.

"A history of preoperative falls is a valuable and pragmatic tool, and should become part of routine preoperative assessment," the researchers concluded. In the accompanying op-ed, Nicholas D. Clement of the Department of Orthopedics and Trauma at the Infirmary of Edinburgh called for the adoption of fall history evaluation before all surgeries - as well as research on fall risk by surgical specialty.

"This does … seem to be the beginning of a long line of investigation which may ultimately decrease the risk of postoperative falls and improve the surgical outcome of 'at risk' patients," Clement wrote.

References:

Kronzer VL, Jerry MR, Abdallah AB, et al. "Preoperative Falls Predict Postoperative Falls, Functional Decline, and Surgical Complications." EBioMedicine. 2016. doi:10.1016/j.ebiom.2016.08.039.

Clement ND. "A History of Falls Should Be Recorded in All Preoperative Patients." EBioMedicine. 2016. doi:10.1016/j.ebiom.2016.09.002.