Friday, November 4, 2016

Inpatient falls after shoulder arthroplasty

These authors evaluated inpatient fall trends after elective shoulder arthroplasty and identified patient and hospital characteristics associated with the occurrence of falls using discharge records from the Nationwide Inpatient Sample (2002-2011).

The rate of in-hospital falls increased from 0% in 2002 to 1.7% in 2011, despite a downward
trend in length of stay (P < .001). 

In rank order the characteristics associated with the occurrence of falls included 

fluid/electrolyte disorder (OR, 3.58; 95% CI, 3.29-3.89), 

opioid use disorder  (OR, 3.33; 95% CI, 1.98- 5.59), 

malnutrition/weight loss (OR, 2.36; 95% CI, 1.71- 3.26), 

chronic anemia (OR, 1.94; 95% CI, 1.53-2.46), 

visual impairment (OR, 1.85; 95% CI, 1.28-2.67), 

nonopioid drug use disorder (OR, 1.76; 95% CI, 1.05-2.96), 

congestive heart failure (OR, 1.57; 95% CI, 1.38-1.79), 

hearing impairment (OR, 1.49; 95% CI, 1.19-1.86)

Hispanic race/ethnicity (OR of 1.34 [95% CI, 1.12-1.60] vs white)

lower household income  (OR of 1.27 [95% CI, 1.15- 1.40] for $1-$38,999 vs ≥ $63,000) and

older age  (OR of 1.22 [95% CI, 1.10-1.36] for ≥ 75 years and OR of 1.18 [95% CI, 1.06-1.30] for 65-74 years vs ≤ 64 years). 

Comment:  These authors point out that postoperative in-hospital falls increase morbidity and the risk for litigation. They are deemed highly preventable by the Centers for Medicare & Medicaid  Services, to the degree that they are now considered a non-reimbursable CMS “never event". It is, therefore, important for surgeons to anticipate fall risk and to take appropriate preventative steps, including preoperative planning and care coordination, optimized medical management, and improved patient/family education and engagement.


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