Surgeons associate preoperative falls with worse postoperative outcomes in older adults

October 1, 2012

An answer to the simple question—"Have you recently taken a fall?"—can tell a surgeon how well an older adult may recover from a major operation according to researchers from the University of Colorado, Denver. New study findings, reported today at the 2012 Annual Clinical Congress of the American College of Surgeons (ACS), indicate that preopera-tive falls in older surgical patients are a powerful predictor of complications, prolonged hospital stays, and higher rates of disability.

"It has been shown in previous studies that a history of falls predicts poor long-term outcomes but we have never looked at immediate preop assessment related to postop outcomes," explained Teresa Jones, MD, lead study author and surgical resident at the University of Colorado. "This is the first time that falls as a stand-alone risk marker have been used for predicting outcomes in older adults."

Falls—a marker of physical frailty—are a risk factor unique to the geriatric population and increase the chance of hospitalization and even death in older adults. In fact, 47 percent of of individuals age 65 and older are the result of fall-related injuries, according to the National Trauma Databank of the American College of Surgeons.*

The study included 208 patients, average age 74, who were undergoing colorectal or cardiac surgical procedures at the Denver Veterans Affairs Medical Center. Dr. Jones and colleagues asked the patients, of whom were mostly male, if they had fallen in the six months prior to their scheduled operation. Preoperative falls occurred in 34 percent of the patients.

Researchers found that adverse outcomes occurred more frequently in patients who had reported one or more falls in that timeframe. For patients undergoing colorectal operations, 58 percent of those who fell sometime prior to their operations experienced more than one postoperative complication versus only 27 percent of those who did not fall. Those complica-tions included ; stroke; reoperation; and pulmonary, renal, thrombotic, and infectious complications.

In addition, patients who reported a postoperative fall spent nearly three times as many days in the hospital as their fall-free counterparts.

Further, 59 percent of those who fell before surgery, as opposed to only 4.2 percent of those who did not, needed institutional care following their operations. Likewise, significant differences were seen in under-going cardiac surgical procedures.

"Our goal is to help with preoperative and postoperative planning," Dr. Jones explained. "If it's likely that a patient will need to enter a nursing home for several weeks after an operation, the patient and family can evaluate various facilities beforehand to see which one would best address their specific needs. "It's important for a patient to be at a place that they've chosen and know what to expect after surgery," Dr. Jones said.

More than one-third of all operations in the United States are now performed on people 65 and older, and the fastest growing segment of the population undergoing various surgical procedures is adults in their 80s, the researchers said. "This assessment is very novel in the sense that older adults have unique risk factors that we can look for that suggest that they will do poorly after an operation, but these markers are not readily recognized by the wider surgical community," said study coauthor Thomas Robinson, MD, FACS, associate professor of surgery at the University of Colorado.

Thus the ultimate aim, the study authors said, is to develop simple tests that will enable the average surgeon to forecast who is going to fare best following an operation. "I think this study is going to improve care by changing how we counsel prior to these major operations," Dr. Robinson said. "We want to tailor the patient's health care plan based upon what will be the best possible outcome. We shouldn't settle for putting people in institutional care facilities for the last six months of their life."

Daniel Wu, MD, chief surgical resident, department of surgery, Denver Veteran's Affairs Medical Center also contributed to this study.

Explore further: Elderly thyroid surgery patients at increased risk for postoperative complications

More information: *Source: American College of Surgeons Committee on Trauma. "Incidents by Selected Mechanism of Injury and Age (Table 17)." 2011 Annual Report of the National Trauma Data Bank. Available at www.facs.org/trauma/ntdb/pdf/n … annualreport2011.pdf. Accessed September 14, 2012.

Related Stories

Elderly thyroid surgery patients at increased risk for postoperative complications

March 29, 2012
Elderly patients who undergo thyroid surgery are at a much higher risk than their younger counterparts for serious cardiac, pulmonary and infectious complications, according to a recent study accepted for publication in The ...

Study finds significantly higher hospital costs for surgical patients who smoke

May 29, 2012
Cigarette smoking contributes to significantly higher hospital costs for smokers undergoing elective general surgery, according to a study published in the June 2012 issue of the Journal of the American College of Surgeons. ...

Landmark guidelines for optimal quality care of geriatric surgical patients just released

September 27, 2012
New comprehensive guidelines for the pre- operative care of the nation's elderly patients have been issued by the American College of Surgeons (ACS) and the American Geriatrics Society (AGS). The joint guidelines—published ...

General surgeons identify postoperative complications posing strongest readmission risk

August 28, 2012
Postoperative complications are the most significant independent risk factor leading to 30-day hospital readmissions among general surgery patients, according to a new exploratory study published in the September issue of ...

Recommended for you

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

Defining optimal opioid pain medication prescription length following surgery

September 27, 2017
A new study led by researchers at the Center for Surgery and Public Health at Brigham and Women's Hospital analyzed opioid prescription data from the Department of Defense Military Health System Data Repository, identifying ...

Is older blood OK to use in a transfusion?

September 27, 2017
(HealthDay)—Using older red blood cells to give transfusions to critically ill patients doesn't appear to affect their risk of dying, Australian researchers report.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.