Preoperative Falls Predict Postoperative Falls, Functional Decline, and Surgical Complications

Vanessa L Kronzer¹, Michelle R Jerry², Arbi Ben Abdallah³, Troy S Wildes⁴, Susan L Stark⁵, Sherry L McKinnon⁶, Daniel L Helsten⁷, Anshuman Sharma⁸, Michael S Avidan⁹

Affiliations

¹ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: vkronzer@wustl.edu.
² University of Michigan, Department of Biostatistics, 534 Canton Street, Canton, MI 48188, USA. Electronic address: kleckner@umich.edu.
³ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: aba@anest.wustl.edu.
⁴ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: wildest@anest.wustl.edu.
⁵ Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, CB 855, Saint Louis, MO 63108, USA. Electronic address: sstark@wustl.edu.
⁶ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: mckinnos@anest.wustl.edu.
⁷ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: helstend@anest.wustl.edu.
⁸ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: sharmanu@anest.wustl.edu.
⁹ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: avidanm@anest.wustl.edu.

PMID: 27599969
PMCID: PMC5078581
DOI: 10.1016/j.ebiom.2016.08.039

Preoperative Falls Predict Postoperative Falls, Functional Decline, and Surgical Complications

Vanessa L Kronzer et al. EBioMedicine. 2016 Oct.

. 2016 Oct:12:302-308.

doi: 10.1016/j.ebiom.2016.08.039. Epub 2016 Aug 26.

Authors

Vanessa L Kronzer¹, Michelle R Jerry², Arbi Ben Abdallah³, Troy S Wildes⁴, Susan L Stark⁵, Sherry L McKinnon⁶, Daniel L Helsten⁷, Anshuman Sharma⁸, Michael S Avidan⁹

Affiliations

¹ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: vkronzer@wustl.edu.
² University of Michigan, Department of Biostatistics, 534 Canton Street, Canton, MI 48188, USA. Electronic address: kleckner@umich.edu.
³ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: aba@anest.wustl.edu.
⁴ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: wildest@anest.wustl.edu.
⁵ Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, CB 855, Saint Louis, MO 63108, USA. Electronic address: sstark@wustl.edu.
⁶ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: mckinnos@anest.wustl.edu.
⁷ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: helstend@anest.wustl.edu.
⁸ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: sharmanu@anest.wustl.edu.
⁹ Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: avidanm@anest.wustl.edu.

PMID: 27599969
PMCID: PMC5078581
DOI: 10.1016/j.ebiom.2016.08.039

Abstract

Background: Falls are common and linked to morbidity. Our objectives were to characterize postoperative falls, and determine whether preoperative falls independently predicted postoperative falls (primary outcome), functional dependence, quality of life, complications, and readmission.

Methods: This prospective cohort study included 7982 unselected patients undergoing elective surgery. Data were collected from the medical record, a baseline survey, and follow-up surveys approximately 30days and one year after surgery.

Results: Fall rates (per 100 person-years) peaked at 175 (hospitalization), declined to 140 (30-day survey), and then to 97 (one-year survey). After controlling for confounders, a history of one, two, and ≥three preoperative falls predicted postoperative falls at 30days (adjusted odds ratios [aOR] 2.3, 3.6, 5.5) and one year (aOR 2.3, 3.4, 6.9). One, two, and ≥three falls predicted functional decline at 30days (aOR 1.2, 2.4, 2.4) and one year (aOR 1.3, 1.5, 3.2), along with in-hospital complications (aOR 1.2, 1.3, 2.0). Fall history predicted adverse outcomes better than commonly-used metrics, but did not predict quality of life deterioration or readmission.

Conclusions: Falls are common after surgery, and preoperative falls herald postoperative falls and other adverse outcomes. A history of preoperative falls should be routinely ascertained.

Keywords: Accidental falls; Elective surgical procedures; Outcome assessment; Patient-reported outcomes; Postoperative period; Preoperative period.

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Figures

**Fig. 1**
Percent of patients who reported falling in the year after surgery, stratified by number of preoperative falls. Legend: Error bars represent 99% confidence intervals.

**Fig. 2**
Actual and estimated perioperative fall rates.

**Fig. 3**
Fall rate at baseline, 30 days, and one year, by surgical specialty. Legend: GI = Gastrointestinal.

See this image and copyright information in PMC

References

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Preoperative Falls Predict Postoperative Falls, Functional Decline, and Surgical Complications

Affiliations

Preoperative Falls Predict Postoperative Falls, Functional Decline, and Surgical Complications

Authors

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Abstract

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