Preoperative Falls Predict Postoperative Falls, Functional Decline, and Surgical Complications
| Autor: | Daniel L. Helsten, Michelle R. Jerry, Troy S. Wildes, BS Sherry L. McKinnon, Arbi Ben Abdallah, MBBCh Michael S. Avidan, Vanessa L. Kronzer, Susan Stark, Anshuman Sharma |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Time Factors lcsh:Medicine Elective surgical procedures 030204 cardiovascular system & hematology Strengthening the reporting of observational studies in epidemiology NMAR not missing at random Metabolic equivalent 0302 clinical medicine Postoperative Complications Quality of life Outcome Assessment Health Care Odds Ratio 030212 general & internal medicine Prospective Studies Prospective cohort study SATISFY-SOS Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys Accidental falls lcsh:R5-920 Medical record ASA American Society of Anesthesiologists Preoperative period General Medicine 3. Good health Hospitalization STROBE STrengthening the Reporting of OBservational studies in Epidemiology Population Surveillance Female METs metabolic equivalents lcsh:Medicine (General) Elective Surgical Procedure Research Paper medicine.medical_specialty General Biochemistry Genetics and Molecular Biology 03 medical and health sciences medicine Postoperative period Humans Elective surgery MAR missing at random Patient-reported outcomes business.industry lcsh:R BRFSS Behavior Risk Factor Surveillance System Odds ratio Surgery Outcome assessment Emergency medicine Quality of Life ProFaNE Prevention of Falls Network Europe business |
| Zdroj: | EBioMedicine EBioMedicine, Vol 12, Iss C, Pp 302-308 (2016) |
| ISSN: | 2352-3964 |
| Popis: | 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 30 days 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 30 days (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 30 days (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. Highlights • Postoperative falls are common during hospitalization and after discharge and may be more prevalent in certain specialties. • Preoperative falls predict postoperative falls, postoperative functional decline, and in-hospital complications. • Ascertaining fall history is practical and informative, and should become routine. Surgery-related falls occur at a high rate both during hospitalization and after discharge, and they may be especially prevalent in certain surgical specialties. Preoperative falls are the main harbinger of postoperative falls, and also strongly predict postoperative functional decline and complications. Importantly, these findings appear to be true across all ages. Therefore, a history of falls before surgery is a useful tool that should be incorporated into routine preoperative assessment. |
| Databáze: | OpenAIRE |
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