Relationship Between Asking an Older Adult About Falls and Surgical Outcomes

• Published in: JAMA surgery Vol. 148; no. 12; p. 1132
• Main Authors: Jones, Teresa S, Dunn, Christina L, Wu, Daniel S, Cleveland, Joseph C, Kile, Deidre, Robinson, Thomas N
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01.12.2013
• Subjects: Academic Medical Centers; Accidental Falls - statistics & numerical data; Aged; Aged, 80 and over; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cohort Studies; Colorectal Surgery - adverse effects; Colorectal Surgery - methods; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - methods; Elective Surgical Procedures - mortality; Female; Geriatric Assessment - methods; Hospital Mortality; Humans; Male; Medical History Taking - methods; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Predictive Value of Tests; Preoperative Care - methods; Prognosis; Prospective Studies; Survival Rate; Treatment Outcome
• ISSN: 2168-6254; 2168-6262; 2168-6262
• DOI: 10.1001/jamasurg.2013.2741

IMPORTANCE More than one-third of all US inpatient operations are performed on patients aged 65 years and older. Existing preoperative risk assessment strategies are not adequate to meet the needs of the aging population. OBJECTIVES To evaluate the relationship of a history of falls (a geriatric syndrome) to postoperative outcomes in older adults undergoing major elective operations. DESIGN, SETTING, AND PARTICIPANTS This prospective, cohort study was conducted at a referral medical center. Persons aged 65 years and older undergoing elective colorectal and cardiac operations were enrolled. The predictor variable was having fallen in the 6 months prior to the operation. MAIN OUTCOMES AND MEASURES Postoperative outcomes measured included 30-day complications, the need for discharge institutionalization, and 30-day readmission. RESULTS There were 235 subjects with a mean (SD) age of 74 (6) years. Preoperative falls occurred in 33%. One or more postoperative complications occurred more frequently in the group with prior falls compared with the nonfallers following both colorectal (59% vs 25%; P = .004) and cardiac (39% vs 15%; P = .002) operations. These findings were independent of advancing chronologic age. The need for discharge to an institutional care facility occurred more frequently in the group that had fallen in comparison with the nonfallers 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) operations. CONCLUSIONS AND RELEVANCE A history of 1 or more falls in the 6 months prior to an operation forecasts increased postoperative complications, the need for discharge institutionalization, and 30-day readmission across surgical specialties. Using a history of prior falls in preoperative risk assessment for an older adult represents a shift from current preoperative assessment strategies.