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Relationship between asking an older adult about falls and surgical outcomes.
JAMA Surg 2013; 148(12):1132-8JS

Abstract

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.

Authors+Show Affiliations

Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado2Denver Veterans Affairs Medical Center, Denver, Colorado.Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado.Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado2Denver Veterans Affairs Medical Center, Denver, Colorado.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24108317

Citation

Jones, Teresa S., et al. "Relationship Between Asking an Older Adult About Falls and Surgical Outcomes." JAMA Surgery, vol. 148, no. 12, 2013, pp. 1132-8.
Jones TS, Dunn CL, Wu DS, et al. Relationship between asking an older adult about falls and surgical outcomes. JAMA Surg. 2013;148(12):1132-8.
Jones, T. S., Dunn, C. L., Wu, D. S., Cleveland, J. C., Kile, D., & Robinson, T. N. (2013). Relationship between asking an older adult about falls and surgical outcomes. JAMA Surgery, 148(12), pp. 1132-8. doi:10.1001/jamasurg.2013.2741.
Jones TS, et al. Relationship Between Asking an Older Adult About Falls and Surgical Outcomes. JAMA Surg. 2013;148(12):1132-8. PubMed PMID: 24108317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between asking an older adult about falls and surgical outcomes. AU - Jones,Teresa S, AU - Dunn,Christina L, AU - Wu,Daniel S, AU - Cleveland,Joseph C,Jr AU - Kile,Deidre, AU - Robinson,Thomas N, PY - 2013/10/11/entrez PY - 2013/10/11/pubmed PY - 2014/2/19/medline SP - 1132 EP - 8 JF - JAMA surgery JO - JAMA Surg VL - 148 IS - 12 N2 - 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. SN - 2168-6262 UR - https://www.unboundmedicine.com/medline/citation/24108317/Relationship_between_asking_an_older_adult_about_falls_and_surgical_outcomes_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2013.2741 DB - PRIME DP - Unbound Medicine ER -