Relationship Between Asking an Older Adult About Falls and Surgical Outcomes

Abstract

Objective(s) The purpose of this study was to evaluate the relationship of a history of falls (a geriatric syndrome) to postoperative outcomes in older adults undergoing major elective operations. Design Prospective, cohort study. Setting Referral medical center. Patients Persons 65 years and older undergoing elective colorectal and cardiac operations were enrolled. The predictor variable was having fallen in the six months prior to the operation. Interventions None. Main Outcome Measures Postoperative outcomes measured included thirty-day complications, need for discharge institutionalization and thirty-day readmission. Results There were 235 subjects with a mean age of 74±6 years. Pre-operative falls occurred in 33%. One or more postoperative complications occurred more frequently in the group with prior falls compared to the non-fallers following both colorectal (59% vs. 25%; p=0.004) and cardiac (39% vs. 15%; p=0.002) operations. These findings were independent of advancing chronologic age. Need for discharge to an institutional care facility occurred more frequently in the group that had fallen in comparison to the non-fallers in both the colorectal (52% vs. 6%; p<0.001) and cardiac (62% vs. 32%; p=0.001) groups. Similarly, 30-day readmission was higher in the group with prior falls following both colorectal (p=0.043) and cardiac (p=0.016) operations. Conclusions A history of one or more falls in the six months prior to an operation forecasts increased postoperative complications, need for discharge institutionalization and thirty-day readmission across surgical specialties. Utilizing a history of prior falls in preoperative risk assessment for an older adult represents a shift from current preoperative assessment strategies.

Influence of Admission to a Tertiary Care Hospital after a Fall on Use of Potentially Inappropriate Medications among Older Patients

“…The connection between these 2 factors was further supported by the observation that admission to the orthopedics service was not associated with de-escalation of PIMs upon univariate analysis but was a significant predictor upon multivariate analysis with geriatric consultation also included in the model. Routine geriatrics consultation for elderly surgical patients has recently been shown to be associated with improved functional recovery, 15 and the findings of the current study further emphasize this value.…”

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

“…Unfortunately, the study did not include any objective measurements of physical performance. In comparison, a study from the USA that investigated the impact of a history of falls on postoperative complications in gastrointestinal surgery found that 100% of patients with three or more falls in the preceding 6 months experienced postoperative morbidity [47].…”

Rehabilitation of the Geriatric Surgical Patient

“…13 Patients undergoing elective cardiac or colorectal surgery were asked if they had suffered a fall in the previous 6 months. One-third of the cohort of 235 patients had fallen, and falls were significantly associated with complications, readmissions, and institutionalization.…”