0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation | SURGICAL CARE OF THE AGING POPULATION

Relationship Between Asking an Older Adult About Falls and Surgical Outcomes

Teresa S. Jones, MD1; Christina L. Dunn, BA1; Daniel S. Wu, MD1; Joseph C. Cleveland Jr, MD1,2; Deidre Kile, MS3; Thomas N. Robinson, MD, MS1,2
[+] Author Affiliations
1Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
2Denver Veterans Affairs Medical Center, Denver, Colorado
3Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
JAMA Surg. 2013;148(12):1132-1138. doi:10.1001/jamasurg.2013.2741.
Text Size: A A A
Published online

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.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Study Enrollment Flowchart
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Prior Falls and Postoperative Complications in Colorectal Operations
Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Falls: The First Clue of Surgical Outcomes Database Modifications Needed to Accommodate Older Adults

The traditional variables used to quantify surgical risk include chronic diseases and single end-organ dysfunction (left). These variables are amenable to retrospective medical record review collection by looking at the surgeon’s history/physical note or the preanesthesia evaluation and, as a result, are currently used by the National Surgical Quality Improvement Program (NSQIP) data set to forecast surgical risk. Relying solely on chronic disease burden to quantify surgical risk in older adults is inadequate. Frailty-specific variables reveal reduced physiologic reserve specific to the older adult (right). These frailty variables are not currently used in surgical risk calculators because they are not commonly recorded in the surgical medical record and, therefore, cannot be collected through retrospective medical record review. There are few variables that both quantify the unique physiologic vulnerability of the older adult and can be collected by retrospective medical record review, which allows for their inclusion in surgical outcomes data sets (area where circles overlap). Potential variables to include in a geriatric-specific surgical outcomes data set are listed in the bottom box. These variables are often accessible by reading nursing inpatient admission notes, which include nutrition, mobility, and fall and pressure sore risk assessments. Examples of 2 commonly recorded nursing assessment scales include (1) the Morse Fall Risk Score (used to quantify inpatient fall risk), which documents fall history, ambulatory aid use, gait/transfer difficulties, and mental status; and (2) the Braden Score (used to quantify pressure sore risk), which documents activity, mobility, and nutrition. COPD indicates chronic obstructive pulmonary disease.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Related Multimedia

Author Interview

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination
Case Resolution

The Rational Clinical Examination
Clinical Scenarios

brightcove.createExperiences();