Falls before surgery are common at all ages, but especially middle-age

By Liz Meszaros, MDLinx
Published July 7, 2016

Key Takeaways

Falls up to 6 months before surgery are not only common in all age groups—young, middle-aged, elderly—they may even be slightly more frequent in middle-aged individuals, according to study results published online June 30 in Anesthesiology, the journal of the American Society of Anesthesiologists.

“A history of falls is likely to be a marker of patient vulnerability and poor health,” said senior author, Michael S. Avidan, MBBCh, professor of surgery, chief of the Division of Cardiothoracic Anesthesiology, and the Dr. Seymour and Rose T. Brown Professor of Anesthesiology at Washington University School of Medicine, St. Louis, MO.

Dr. Avidan and fellow researchers conducted this observational study, for which they collected 15,060 surveys for 18 months (between January 2014 and August 2015) from adult patients who had undergone elective surgeries. They found that in the 6 months before surgery, a full 26% (99% CI, 25% to 27%) of patients fell at least once, and 12% (99% CI, 11% to 13%) at least twice.

They also found the following:

  • A full 58% of those who fell (99% CI, 56% to 60%) sustained at least one fall-related injury.
  • Patients presenting for neurosurgery seemed to have the largest proportion of falls, at 41% (99% CI, 36% to 45%).
  • Falls within 6 months of surgery were independently associated with pre-operative functional dependence (OR: 1.94; 99% CI, 1.68-2.24).
  • Falls within 6 months of surgery were also independently associated with poor physical quality of life (OR: 2.18; 99% CI, 1.88-2.52).

Surprisingly, they discovered the highest proportion of fallers (28%) among middle-aged patients aged 45 to 64 years, as well as the highest proportion of recurrent fallers (13%) and severe fall-related injuries (27%), in comparison to both younger and older patients (P < 0.0001 for each).

“This is the time of life when physical decline starts to occur; however, the individual may not be aware of it yet. Falling may indicate that physical decline is beginning, giving physicians valuable insight that ultimately may lead to positive post-surgical outcomes,” said lead author Vanessa L. Kronzer, a Washington University medical student.

In comparison, 26% of those aged ≥ 65 years fell, 11% being recurrent fallers; and 24% of patients aged ≤ 44 years, with 12% recurrent fallers.

“As you can see, those numbers are not very different, and that’s exactly the point,” Kronzer noted. “We were expecting to see a large increase in the percentage of falls from young adulthood to middle age to older age, but that didn’t happen. Instead, the percentage of people who fell was similar across all ages. This finding suggests we may need to reconsider which patients are most at risk of falling.”

When they assessed possible contributing factors, they found that falls occurred most frequently in patients with osteoarthritis, rheumatoid arthritis, incontinence, impaired mobility, dizziness, and poor perceived health. They also noted that in those aged 50 years and older, depression seemed to have an association with an increased chance of falls, while in those aged 44 years and younger, it was osteoarthritis.

“Our study suggests that a history of falls may help to detect aspects of poor health that are not usually found in the process of obtaining a patient’s medical history and conducting a physical examination. This is probably because a history of falls provides insight into a patient’s health that is not related to specific conditions such as diabetes and heart disease,” Avidan concluded.

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