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Affiliation
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The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH. |
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Abstract
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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 prior to the operation with discharge to a facility, readmissions, and complications in the first 30-days post-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, there were 143 elderly patients who 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 (OR, 1.35; 95% 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 one fall in the 6 months prior to a neurosurgical operation was associated with increased risk of discharge to a facility, readmissions, and complications in the first 30-days post-discharge. History of prior falls should be taken into account during the preoperative risk assessment of neurosurgical patients.
Copyright © 2016 Elsevier Inc. All rights reserved.
Language: en |