A history of falls in the 6 months prior to surgery was associated with increased postoperative complications in both colorectal (59% vs 25%; P=.004) and cardiac (39% vs 15%; P=.002) operations.
Cohort (n=235)
No
Does a history of falls predict postoperative complications, institutionalization, and readmission in older adults undergoing major elective operations?
A history of falls in the 6 months prior to surgery is a strong predictor of postoperative complications, institutionalization, and 30-day readmission in older adults.
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.
Jones et al. (Fri,) conducted a cohort in Elective colorectal and cardiac operations (n=235). History of falls in the prior 6 months vs. No history of falls was evaluated on 30-day postoperative complications, discharge institutionalization, and 30-day readmission. A history of falls in the 6 months prior to surgery was associated with increased postoperative complications in both colorectal (59% vs 25%; P=.004) and cardiac (39% vs 15%; P=.002) operations.