Falls linked to postoperative complications in elderly

A history of 1 or more falls in the 6 months prior to an operation forecasts increased postoperative complications, need for discharge institutionalization, and 30-day readmission across surgical specialties, according to a study published in JAMA Surgery online October 9, 2013.

Thomas Robinson, associate professor of surgery at the University of Colorado School of Medicine in Aurora, and colleagues conducted a prospective cohort study which included 235 mostly male patients aged 65 years and older undergoing colorectal or cardiac operations. The patients were asked whether they had fallen in the 6 months leading up to an operation. The number of adverse postoperative events occurring in the group that did and did not have a preoperative fall was compared.

Preoperative falls occurred in 33% of the patients. One or more postoperative complications occurred more often in the patients with prior falls compared with those who did not fall following both colorectal (59% vs 25%; P=.004) and cardiac (39% vs 15%; P=.002) surgery. These findings were independent of advancing chronologic age. The need for discharge to an institutional care facility occurred more frequently in the patients who had fallen, in comparison with the patients who did not fall, in both the colorectal (52% vs 6%; P=.001) and cardiac (62% vs 32%; P=.001) groups. Similarly, 30-day readmission was higher in the group with prior falls following both colorectal (P=.04) and cardiac (P=.02) surgery, according to the study.

“Assessment of the frail older adult is an important part of the preoperative evaluation of the elderly. The traditional tactic of recording comorbidities [eg, hypertension, renal insufficiency] is not the best approach for the frail elderly,” Dr Robinson told Formulary.

“This study was done because a history of prior falls is a variable which can be retrospectively collected by chart review,” he said. “This fact makes a history of falls amenable to be recorded in large national surgical outcome databases. Including a geriatric specific variable in national surgical outcome datasets will allow improved risk stratification for older adults undergoing operations.

“Characteristics of the frail elderly, such as a history of prior falls, are an important part of the preoperative evaluation of older adults,” Dr Robinson concluded.