Study identifies factors that increase risk of falls among orthopedic inpatients

Patients who undergo total hip replacement display a higher risk of serious falls during recovery than patients who undergo other orthopedic procedures, according to the results of a recently presented study.

The findings, which were presented at the 2010 Annual Meeting of the American College of Rheumatology, also identified other factors involved in patient falls that could help hospitals devise strategies to reduce such accidents.

“Patients undergoing total hip replacements appear more likely to have more serious falls than other orthopedic patients, and serious falls happen earlier than most falls — 2 days postoperatively rather than 4 when most falls occurred,” Lisa A. Mandl, MD, an author of the study and rheumatologist at Hospital for Special Surgery (HSS) in New York, stated in an HSS press release. “[Total hip replacement] patients should be monitored closely, especially during the first 3 postoperative days. This study identified a window in which we might need to be more careful than we thought.”

Methods and findings

Investigators with the Quality Research Center at HSS conducted a retrospective review of patients who had fallen in their hospital from 2000 to 2009 using the hospital’s fall reporting database and discharge records. The investigators noted that the fall rate at the hospital — which caters primarily to elective orthopedic procedure patients — was 0.9% of admissions and 2.0 falls per 1,000 inpatient days.

The group reported no association between falling and body mass index, age, gender, location in the hospital, day of the week or time of day. It was found that 13.1% of first falls resulted in injuries, of which 3.3% were categorized as serious — defined as transfer to a higher level of care, dislocation, fracture, intra-cranial bleed or need for an operation. Patients with serious falls were more likely to fall earlier in their stay and have a total hip replacement (THR).

Among patients who fell, 38.2% had a total knee replacement, 18.5% had a spine procedure, 14.7% had a THR, 11.5% had a lower extremity procedure and 8.9% were admitted for another procedure or medical reason. Of the 842 falls that were characterized as first falls during the admission, 45.1% involved a patient using the bathroom.

Need for vigilance

According to the study, 17.5% of first falls were in patients with a known history of previous falls. Twenty-six falls were second or third falls in the same patient during the same admission.

“We know that a previous fall puts you at risk for a future fall, and even though we knew these people were high risk, they still fell,” Mandl stated in the release. “We weren’t able to stop it. That tells us that whatever we are doing now is not really good enough. We need to be more vigilant about people who are high risk.”

The investigators also pointed out that they did not identify any trend in the fall rate during the time that the study was conducted – the rate stayed constant.

“In spite of everything we have done to improve the rates for falls, the rates have not really changed over the last decade,” Mandl stated.

Reference:
Mandl LA, Parks M, Quinlan P, et al. Who Falls? A Decade of Experience at a Musculoskeletal Specialty Hospital. Poster #1573. Presented at Presented at the 2010 ACR Annual Scientific Meeting. November 7-11. Atlanta.

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