Falls Among Patients Who Had Elective Orthopaedic Surgery: A Decade of Experience From a Musculoskeletal Specialty Hospital

Abstract

Study Design Retrospective cohort study. Objective To evaluate falls among elective orthopaedic inpatients at a musculoskeletal hospital. Background Falls are the most commonly reported hospital incidents. Approximately 30% of in-hospital falls result in minor injury, and up to 8% of falls result in moderate to severe injury. Given the projected rise in elective orthopaedic procedures, it is important to better understand fall patterns in this population. Methods A retrospective review of electronic medical records and patient charts (2000–2009) was conducted to identify falls in patients admitted for elective orthopaedic procedures. Results There were 868 falls among orthopaedic patients older than 18 years. The fall rate was 0.9% of admissions, or 2.0 falls per 1000 inpatient days. The average age of the patients who had fallen was 68 years, and 57.6% were women. Knee replacements (38.2%), spine procedures (18.5%), and hip replacements (14.7%) were the procedures most commonly associated with falls. Three hundred eighty-six falls (45.8%) involved bathroom usage. One hundred ten first falls (13.1%) resulted in injuries. Twenty-eight falls (3.3%) resulted in serious events, including 5 returns to the operating room, 3 transfers to a higher level of care, 14 prosthesis dislocations, 6 fractures, 2 intracranial bleeds, and 1 hemorrhage. Patients with serious injuries were more likely to fall earlier (mean postoperative days, 2.7 versus 4.1; mean difference, 1.4 days; 95% confidence interval: 0.51, 2.3; P = .003) and to have had hip replacement (odds ratio = 3.7; 95% confidence interval: 1.7, 8.2). Serious injuries were not associated with body mass index, age, gender, hospital location, day, or fall history. Conclusion Falls are avoidable events that are poorly described among orthopaedic patients having elective procedures. This large series identifies hip replacement patients as being at almost 4-fold risk of having a serious adverse event after falling. Larger prospective trials are needed to confirm results and to inform prevention strategies. J Orthop Sports Phys Ther 2013;43(2):91–96. doi:10.2519/jospt.2013.4349

Nationwide time trends and risk factors for in-hospital falls-related major injuries

“…Most in-hospital falls are caused by an interaction between environmental and patient-related risk factors (12). Many studies have looked at environmental risk factors and circumstances for in-hospital falls (5,8,12,13). Other studies have identified associations between patients with in-hospital falls and level of comorbidity (4,14), medication (8,(15)(16)(17), general muscle weakness and problems with balance (8,(15)(16)(17), fall history (8) and confusion (4,7,8,13,(15)(16)(17)(18).…”

Quelle analgésie pour la reprise rapide de la marche ?

“…L'instabilité du membre inférieur peut être également due à la douleur qui agit en inhibant l'action des muscles stabilisateurs du genou (réflexe nociceptif en flexion). En chirurgie orthopé-dique sans aucune précision des techniques anesthésiques, le taux de chute était de 0,9 % soit 2 chutes pour 1000 jours d'hospitalisation (868 chutes sur une période de 10 ans) [24]. Pour les patients opérés d'une prothèse articulaire de hanche ou de genou, cela représentait 0,85 %, soit 2,1 chutes pour 1000 jours d'hospitalisation [25].…”

Fall-related admissions after fast-track total hip and knee arthroplasty - cause of concern or consequence of success?

“…Falls are common in the elderly, both in and out of hospital,1–7 with potential severe consequences, including fractures and other injuries, as well as more lasting effects, such as disability and fear of falling 2,8. Studies have found in-hospital fall rates after elective orthopedic surgery of about 1%,1,2,4 related to age, gender, and comorbidity1,4 or the use of femoral local anesthetic neural blockade 1,9.…”

“…Studies have found in-hospital fall rates after elective orthopedic surgery of about 1%,1,2,4 related to age, gender, and comorbidity1,4 or the use of femoral local anesthetic neural blockade 1,9. Several studies have tried to identify patient characteristic and circumstances associated with falling,3,5,10 to develop strategies for fall-prevention in community dwellers and medical patients3,11 but not in elective arthroplasty patients after discharge.…”