title: Falls among patients who had elective orthopaedic surgery: a decade of experience from a musculoskeletal specialty hospital.
abstract: METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Division of Rheumatology and the Quality Research Center, Hospital for Special Surgery, New York, NY, USA. mandlL@HSS.edu
authors: Lisa A
authors: LA
authors: Mandl
authors: Stephen
authors: S
authors: Lyman
authors: Patricia
authors: P
authors: Quinlan
authors: Tina
authors: T
authors: Bailey
authors: Jacklyn
authors: J
authors: Katz
authors: Steven K
authors: SK
authors: Magid
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures; D057286:Electronic Health Records; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009519:New York City; D009985:Orthopedics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult