Preoperative Falls and Their Association with Functional Dependence and Quality of Life

Abstract

Background No study has rigorously explored the characteristics of surgical patients with recent preoperative falls. Our objective was to describe the essential features of preoperative falls and determine whether they are associated with preoperative functional dependence and poor quality of life. Methods This was an observational study involving 15,060 surveys from adult patients undergoing elective surgery. The surveys were collected between January 2014 and August 2015, with a response rate of 92%. Results In the 6 months before surgery, 26% (99% CI, 25 to 27%) of patients fell at least once, and 12% (99% CI, 11 to 13%) fell at least twice. The proportion of patients who fell was highest among patients presenting for neurosurgery (41%; 99% CI, 36 to 45%). At least one fall-related injury occurred in 58% (99% CI, 56 to 60%) of those who fell. Falls were common in all age groups, but surprisingly, they did not increase monotonically with age. Middle-aged patients (45 to 64 yr) had the highest proportion of fallers (28%), recurrent fallers (13%), and severe fall-related injuries (27%) compared to younger (18 to 44 yr) and older (65+ yr) patients (P < 0.001 for each). A fall within 6 months was independently associated with preoperative functional dependence (odds ratio, 1.94; 99% CI, 1.68 to 2.24) and poor physical quality of life (odds ratio, 2.18; 99% CI, 1.88 to 2.52). Conclusions Preoperative falls might be common and are possibly often injurious in the presurgical population, across all ages. A history of falls could enhance the assessment of preoperative functional dependence and quality of life.

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

“…In other words, the effect of preoperative falls on poor postoperative outcomes appears to be similar across all ages. Our previous work shows that preoperative falls are common and result in severe injuries for adults of all ages, especially in middle age (Kronzer et al, 2016b), Together, these findings suggest that perioperative fall interventions should be geared towards patients of all ages.…”

“…The low number of risk factors for postoperative falls is surprising since the thirteen variables we tested are strongly associated with falls in the general population (Tinetti and Kumar, 2010, Deandrea et al, 2010) and in our preoperative population (Kronzer et al, 2016b). In spite of this finding, the association between preoperative falls and postoperative falls was quite strong.…”

“…The association between preoperative falls and functional decline is not surprising given the relationship between falls and function in the general and preoperative populations (Skalska et al, 2014, Kronzer et al, 2016b). Nevertheless, the observed associations were stronger than expected.…”

“…The stronger associations were striking, even with the conservative 99% confidence intervals. Approximately 5% of patients report falling three or more times before surgery (Kronzer et al, 2016b). This group is sufficiently small and the risk sufficiently high to justify interventions, which could change their postoperative health trajectories.…”

“…Falls are also associated with functional dependence and poor quality of life in the preoperative surgical population (Kronzer et al, 2016b). A link may therefore also exist between falls and outcomes in surgical populations.…”