Preoperative Screening in Patients having Elective Shoulder Surgery Reveals a High Rate of Fall Risk
These authors point out that patients having shoulder surgery are at increased risk for falls for a number of reasons, including advanced age, impaired upper extremity function, the use of shoulder abduction braces, and postoperative use of opioid medications.
Their goal was to examine preoperative fall risk in patients undergoing elective shoulder surgery. They suggest that gait speed and Timed Up and Go (TUG) are well-researched functional measures in the aging population with established cut-off scores indicating increased fall risk.The TUG score (>14 seconds considered high fall risk) and 10 Meter Walk test (<0.7 m/s considered high risk for falls) were recorded for each patient.
They quantified gait speed and TUG scores in a series of patients who were scheduled to undergo either rotator cuff repair (RCR) or total shoulder arthroplasty (TSA).
Fifty-nine percent of all patients were classified as being a high risk for falls based on gait speed <0.7 m/s. Patients in the TSA group were more likely to display preoperative fall risk compared to patients in the RCR group. Twenty-nine percent of TSA patients and 12% of RCR patients were determined to be at high fall risk based on a TUG score >14 seconds. Although patients in the TSA group were older, there was no association between age or ambulatory status and fall risk.
They conclude that fall risk screening may be important for patients undergoing TSA and RCR surgeries and that higher fall risk in the TSA group may be an important consideration as this procedure shifts toward outpatient status.
Comment: This study uses preoperative measures of fall risk. The preoperative risk is often compounded after surgery by the after effects of anesthesia, pain medications, and shoulder immobilizers. Other important factors include eyesight, railings and lighting on stairs, shoe wear, cardiac conditions, seizures, lower extremity issues, anemia, alcohol, fluid and electrolyte disorders, hearing problems, frailty, dogs, and lack of social support.
In that the consequences of falls after surgery can be major (head injury, fractures, tendon disruption, dislocation), a good overall assessment before surgery is necessary as is a careful evaluation before the patient leaves the medical center. Taking a fall and balance history before surgery and checking to be sure the patient can get out of bed and walk securely before discharge are important and simple steps.
A fall can ruin the results of a fine surgery. All efforts at prevention are worthwhile.
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link). How to x-ray the shoulder (see this link). The total shoulder arthroplasty (see this link). The ream and run technique is shown in this link. The cuff tear arthropathy arthroplasty (see this link). The reverse total shoulder arthroplasty (see this link). The smooth and move procedure for irreparable rotator cuff tears (see this link). Shoulder rehabilitation exercises (see this link).
