Preoperative Falls Predict Postoperative Falls, Functional Decline, and Surgical Complications.
BACKGROUND
Falls are common and linked to morbidity. Our objectives were to characterize postoperative falls, and determine whether preoperative falls independently predicted postoperative falls (primary outcome), functional dependence, quality of life, complications, and readmission.


METHODS
This prospective cohort study included 7982 unselected patients undergoing elective surgery. Data were collected from the medical record, a baseline survey, and follow-up surveys approximately 30days and one year after surgery.


RESULTS
Fall rates (per 100 person-years) peaked at 175 (hospitalization), declined to 140 (30-day survey), and then to 97 (one-year survey). After controlling for confounders, a history of one, two, and ≥three preoperative falls predicted postoperative falls at 30days (adjusted odds ratios [aOR] 2.3, 3.6, 5.5) and one year (aOR 2.3, 3.4, 6.9). One, two, and ≥three falls predicted functional decline at 30days (aOR 1.2, 2.4, 2.4) and one year (aOR 1.3, 1.5, 3.2), along with in-hospital complications (aOR 1.2, 1.3, 2.0). Fall history predicted adverse outcomes better than commonly-used metrics, but did not predict quality of life deterioration or readmission.


CONCLUSIONS
Falls are common after surgery, and preoperative falls herald postoperative falls and other adverse outcomes. A history of preoperative falls should be routinely ascertained.
Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: vkronzer@wustl.edu.
Vanessa L
VL
Kronzer
University of Michigan, Department of Biostatistics, 534 Canton Street, Canton, MI 48188, USA. Electronic address: kleckner@umich.edu.
Michelle R
MR
Jerry
Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: aba@anest.wustl.edu.
Arbi
A
Ben Abdallah
Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: wildest@anest.wustl.edu.
Troy S
TS
Wildes
Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Avenue, CB 855, Saint Louis, MO 63108, USA. Electronic address: sstark@wustl.edu.
Susan L
SL
Stark
Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: mckinnos@anest.wustl.edu.
Sherry L
SL
McKinnon
Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: helstend@anest.wustl.edu.
Daniel L
DL
Helsten
Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: sharmanu@anest.wustl.edu.
Anshuman
A
Sharma
Washington University School of Medicine, Department of Anesthesiology, 660 South Euclid Avenue, Campus Box 8054, Saint Louis, MO 63110, USA. Electronic address: avidanm@anest.wustl.edu.
Michael S
MS
Avidan
D000058:Accidental Falls / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors
Accidental falls; Elective surgical procedures; Outcome assessment; Patient-reported outcomes; Postoperative period; Preoperative period