Johnson Rebecca L, Duncan Christopher M, Ahn Kyle S, Schroeder Darrell R, Horlocker Terese T, Kopp Sandra L
From the *Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota; †University of California Irvine Department of Anesthesiology & Perioperative Care, Orange, California; and ‡Department of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota.
Anesth Analg. 2014 Nov;119(5):1113-8. doi: 10.1213/ANE.0000000000000438.
Fall prevention has emerged as a national quality metric, a focus for The Joint Commission, because falls after orthopedic surgery can result in serious injury. In this study, we examined patient characteristics and effects of fall-prevention strategies on the incidence of postoperative falls in patients undergoing total knee arthroplasty.
We reviewed electronic records of all patients who fell after total knee arthroplasty between 2003 and 2012 (10 years). Patient demographics, including age, sex, and body mass index, were analyzed. The impact of various fall-prevention efforts, including provider and patient education, Hendrich II Fall Risk Model, fall-alert signs, and the use of patient lifts on the incidence of falls, also was studied.
Between January 2, 2003, and December 31, 2012 (10 years), 15,189 total knee arthroplasties were performed at Methodist Hospital, Mayo Clinic Rochester, MN. The overall fall rate was 15.3 per 1000 patients (95% confidence interval [CI]: 13.4-17.4). The rate varied significantly (P < 0.001) during the 10-year period with an initial increase followed by a gradual decrease after the initiation of the fall-prevention strategies. From multivariable analysis adjusting for the temporal trends over time, the odds of falling were found to increase with older age (odds ratio = 1.7 and 2.0 for those 70-79 and ≥80 compared with those 60-69 years of age; P < 0.001) and were lower for patients undergoing revision compared with primary total knee arthroplasties (odds ratio = 0.6, P = 0.006). There was no statistically significant difference in fall rates by sex or body mass index. Most patient falls (72%; 95% CI: 66%-78%) occurred within their own rooms. Elimination-related falls (those that occurred while in the bathroom, while going to and from the bathroom, or while using a bedside commode) comprised a majority (59%; 95% CI: 53%-65%) of the falls. Most patients who fell were not considered high risk according to the Hendrich II Fall Risk Model. Twenty-three percent of falls were associated with morbidity, including 7 return visits to the operating room and 2 new fractures.
Our data demonstrate a reduction in fall incidence coinciding with the implementation of a multi-intervention fall-prevention strategy. Despite prevention efforts, patients of advanced age, elimination-related activities, and patients in the intermediate phase (late postoperative day 1 through day 3) of recovery continue to have a high risk for falling. Therefore, fall-prevention strategies should continue to provide education to all patients (especially elderly patients) and reinforce practices that will monitor patients within their hospital rooms.
预防跌倒已成为一项全国性的质量指标，是联合委员会关注的重点，因为骨科手术后的跌倒可能导致严重伤害。在本研究中，我们调查了全膝关节置换术患者的特征以及预防跌倒策略对术后跌倒发生率的影响。
我们回顾了2003年至2012年（10年）间所有全膝关节置换术后跌倒患者的电子记录。分析了患者的人口统计学特征，包括年龄、性别和体重指数。还研究了各种预防跌倒措施的影响，包括医护人员和患者教育、亨德里奇二世跌倒风险模型、跌倒警示标志以及使用患者升降机对跌倒发生率的影响。
从2003年1月2日至2012年12月31日（10年），明尼苏达州罗切斯特市梅奥诊所卫理公会医院共进行了15189例全膝关节置换术。总体跌倒率为每1000例患者15.3次（95%置信区间[CI]：13.4 - 17.4）。在这10年期间，跌倒率有显著变化（P < 0.001），起初上升，在实施预防跌倒策略后逐渐下降。经过对随时间变化趋势进行调整的多变量分析发现，跌倒几率随年龄增长而增加（70 - 79岁和≥80岁患者与60 - 69岁患者相比，优势比分别为1.7和2.0；P < 0.001），翻修手术患者的跌倒几率低于初次全膝关节置换术患者（优势比 = 0.6，P = 0.006）。按性别或体重指数划分的跌倒率无统计学显著差异。大多数患者跌倒（72%；95% CI：66% - 78%）发生在自己房间内。与排泄相关的跌倒（在浴室、进出浴室或使用床边便桶时发生的跌倒）占跌倒总数的大部分（59%；95% CI：53% - 65%）。根据亨德里奇二世跌倒风险模型，大多数跌倒患者不被认为是高风险。23%的跌倒与发病相关，包括7次返回手术室和2例新骨折。
我们的数据表明，多干预预防跌倒策略的实施与跌倒发生率的降低相吻合。尽管采取了预防措施，但高龄患者、与排泄相关的活动以及处于恢复中期（术后第1天晚期至第3天）的患者继续有较高的跌倒风险。因此，预防跌倒策略应继续对所有患者（尤其是老年患者）进行教育，并加强在病房内对患者进行监测的措施。
