Postoperative falls may cause serious morbidity. Fall prevention has become part of quality improvement programs at many hospitals. Dr. Rebecca Johnson, Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota, and colleagues ascertained the incidence of falls after total knee arthroplasty (TKA) between 2003 and 2012 to determine whether the incidence decreased with the formal implementation of fall-prevention strategies in 2005 at Mayo Clinic. Their results are discussed the article “Fall-Prevention Strategies and Patient Characteristics that Impact Fall Rates after Total Knee Arthroplasty,” which was published in this month’s issue of Anesthesia and Analgesia.
The authors analyzed data from 15,189 patients who underwent TKA between January 2, 2003, and December 31, 2012. Fall-prevention strategies were formally started in 2005 and improved progressively until 2010. The overall incidence of falls was 1.5% (232 falls/15,189 patients), and the rate of falls decreased significantly over time after an initial increase in 2007. Older age and primary arthroplasty (compared with revision) were independently associated with an increased likelihood of falling. Most falls occurred within the patient’s room on PODs 1 and 2 and were often related to “elimination activities”.
The finding that patients undergoing revision arthroplasty are at less of a risk of falling is perhaps counterintuitive, but the large sample size suggests that the results are robust. The investigators were unable to determine the contribution of each fall-prevention measure to the overall improvement. Femoral nerve blockade was used in most patients so that its potential contribution to the incidence of falls cannot be assessed. However, recent reviews suggest that peripheral nerve block does not increase the prevalence of falls after major orthopedic surgery.
This paper is a valuable contribution to a Cinderella topic that is becoming of increasing importance in perioperative medicine and can have substantial financial consequences for a hospital.