Perioperative inpatient falls for anterior cervical discectomy and fusion patients are on the rise: risk factors associated with this "never event".

BACKGROUND CONTEXT

Patients undergoing anterior cervical discectomy and fusion (ACDF) often have brief inpatient stays and may be at risk for inpatient falls (IPFs). Such IPFs should be preventable and have been termed a "never event" by the National Quality Forum, an affiliate of The Joint Commission. Despite increasing attention to IPF prevention, no studies have investigated the incidence, trends, and factors associated with IPFs among ACDF patients.

PURPOSE

To characterize the trends in the incidence of ACDF-related IPFs and their risk factors.

STUDY DESIGN/SETTING: Retrospective cohort study.

PATIENT SAMPLE

Adult patients who underwent inpatient ACDF between 2010 and Q3 2022 were abstracted from a large, national, multiinsurance administrative claims database.

OUTCOME MEASURES

Incidence, trends, and factors associated with IPFs.

METHODS

Adult patients who had undergone single or multilevel inpatient ACDF were identified by administrative coding. Exclusion criteria included: patients <18 years of age, those who underwent outpatient ACDF, concurrent posterior cervical procedures, thoracic or lumbar fusion, and those with trauma, neoplasm, or infection diagnosed within 90-days prior to surgery. The subset of patients who suffered an IPF were subsequently identified. The annual incidence of IPFs was analyzed over the study years and various risk factors were assessed for their correlation with IPFs by multivariable logistic regression. To determine the association between IPF and length of stay (LOS), patients with relative to without IPF were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) and compared by multivariable logistic regression.

RESULTS

Of the 294,165 inpatient ACDF patients meeting inclusion criteria, IPFs were identified for 5,548 (1.9%). Between 2010 and Q3 2022, the annual incidence of IPFs increased from 309 (1.1%) to 515 (4.8%) for patients undergoing ACDF (p<.001). Independent predictors of an IPF were: hospital-acquired delirium (odds ratio [OR] 4.50), history of prior falls (OR 3.38), hospital-acquired psychosis (OR 3.17), alcohol use disorder (OR 2.68), cervical myelopathy (relative to radiculopathy) (OR 2.66), socioeconomically disadvantaged patients (OR 1.85), history of dementia (OR 1.77), underweight body mass index (BMI <18.5) (OR 1.67), multilevel ACDF (OR 1.43), history of prior cervical surgery (OR 1.41), male sex (OR 1.37), Medicaid insurance (OR 1.34), older age (OR 1.33), patients in the northeast United States (OR 1.15), and obese BMI >30 (OR 1.15) (p<.001 for all). Relative to patients without IPF, patients who suffered an IPF following ACDF demonstrated incrementally increasing odds of extended LOS (4-5 days [OR 2.63], 6 to 7 days [OR 3.85], 7+ days [OR 6.78]) (p<.001 for all).

CONCLUSION

In this robust national sample of patients undergoing inpatient ACDF, IPFs were identified for 1.9%, with an increasing annual incidence over the years. Among these patients, various factors were associated with their occurrence, many of which may be potentially modifiable. These findings have major clinical implications on care pathway optimization regarding early identification of high-risk patients undergoing ACDF and lays a foundation for the refinement of multidisciplinary fall prevention programs.