Association of Prior Falls with Adverse Outcomes After Neurosurgical Operations in the Elderly

• Published in: World neurosurgery 2017-03, Vol.99, p.320-325
• Main Authors: Bekelis, Kimon, Rahmani, Redi, Kim-Hyung, Joon, Calnan, Daniel, MacKenzie, Todd A
• Format: Article
• Language: English
• Subjects: Accidental Falls - statistics & numerical data; Aged; Aged, 80 and over; Cohort Studies; Elderly; Elective Surgical Procedures; Falls; Female; Frailty; Humans; Logistic Models; Male; Multivariate Analysis; Neurosurgery; Neurosurgical Procedures; Odds Ratio; Patient Discharge; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Preoperative risk assessment; Propensity Score; Prospective Studies; Rehabilitation Centers; Risk Assessment; Risk Factors; Skilled Nursing Facilities
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.12.023

Background Despite the increasing number of elderly patients undergoing neurosurgical interventions, there are limited resources for preoperative assessment of frailty in this population. We investigated the association between recent history of falls and surgical outcomes for these patients. Methods We performed a prospective cohort study of all patients, 65 years and older, undergoing elective neurosurgical procedures from 2014–2015 in a tertiary referral medical center. We examined the association of sustaining a fall in the 6 months before the operation with discharge to a facility, readmissions, and complications in the first 30 days after discharge. In order to control for confounding, we used multivariable regression models and propensity score conditioning. Mixed-effects models were used to control for clustering at the surgeon level. Results During the study period, 143 elderly patients underwent a neurosurgical procedure and met the inclusion criteria. Of these, 53.1% had a history of falls preoperatively. Mixed-effects multivariable logistic regression analysis demonstrated an association between preoperative falls and discharge to a facility (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.23–1.47), 30-day readmissions (OR, 1.57; 95% CI, 1.36–1.78), and 30-day complications (OR, 1.13; 95% CI, 1.03–1.23). Similar associations were present in propensity score–adjusted models and models stratified by cranial and spinal procedures. Conclusions History of at least 1 fall in the 6 months before a neurosurgical operation was associated with increased risk of discharge to a facility, readmissions, and complications in the first 30 days after discharge. History of prior falls should be taken into account during the preoperative risk assessment of neurosurgical patients.