Preoperative tip for cardiac surgeons: Ask about falls

Cardiac surgeons may be able to gauge the likelihood of postoperative complications by asking geriatric patients preoperatively if they have taken a tumble within the last six months, according to researchers at the University of Colorado, Denver.

In an abstract presented at the annual Clinical Congress of the American College of Surgeons in Chicago, Teresa S. Jones, MD, and colleagues asked 208 elderly patients who were to undergo colorectal or cardiac surgeries at the Denver Veterans Affairs Medical Center if they had fallen in the last six months. Their reasoning for the question was that falls indicate physical frailty.

“It has been shown in previous studies that a history of falls predicts poor long-term outcomes but we have never looked at immediate preop assessment related to postop outcomes,” Jones said in a release. “This is the first time that falls as a stand-alone risk marker have been used for predicting outcomes in older adults.”

Jones and colleagues enrolled the patients prospectively and preoperatively recorded if patients had experienced one or more falls six months before their operation. The researchers also recorded postoperative outcomes as defined by the American College of Surgeons National Surgical Quality Improvement Program, which reports 30-day morbidity and mortality outcomes for major inpatient and outpatient surgical procedures.

The patients had a mean age of 74 years. Of the 208 patients, 34 percent reported preoperative falls.

Of the 129 patients who underwent cardiac surgical procedures, 32.5 percent of those who reported a fall had one or more postoperative complication compared with 16.9 percent of those who did not experience a fall. The length of stay was a day and a half longer for patients who fell. The patients who fell had higher rates of 30-day readmissions and discharge to an institutional care facility.

Researchers found higher rates of adverse outcomes occurring among patients who reported prior falls and who then underwent colorectal surgeries as well.

“Because of its significant association with poor outcomes, a history of falls would be essential in counseling patients regarding preoperative risk,” Jones and colleagues wrote. “In addition, these data may be used to justify incorporation of fall history into large surgical datasets.”

The study findings were presented Oct. 1.