A history of one or more falls in the six months before surgery appears to be an indicator of complications, the need to be discharged to a care facility and 30-day readmission after surgery, according to a study.
More than a third of all U.S. inpatient operations are performed on patients 65 and older, a proportion that will increase during the next several decades, according to background information in the study, which was published Oct. 9 on the website of JAMA Surgery. Existing preoperative risk assessment strategies do not quantify the risk that comes from being frail, the study authors said.
Teresa S. Jones, MD, of the University of Colorado School of Medicine in Aurora, and colleagues sought to evaluate the relationship between older patients with a history of falls in the preceding six months of a major elective operation and postoperative outcomes. The study included 235 patients, average age 74, who were undergoing elective colorectal and cardiac operations. Of the patients, 33% had preoperative falls.
Cardiac, respiratory, neurologic and other postoperative complications occurred more frequently in the group with prior falls compared with those patients who had not fallen following both colorectal (59% vs. 25%) and cardiac (39% vs. 15%) operations, according to the data. The need to be discharged to a care facility also occurred more frequently in the group that had fallen, and 30-day readmission rates were higher.
Given the high volume of surgical care provided for the elderly population, improving preoperative risk assessment for the older adult is becoming increasingly important, the authors concluded. Incorporating geriatric-specific variables that reflect physiologic vulnerability of the older adult into large surgical outcomes data sets used to construct preoperative risk calculators has real potential to improve the accuracy of these tools at forecasting risk in older adults.