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Falls tied to post-op complications in older people

By Andrew M. Seaman

NEW YORK (Reuters Health) - The number of falls older people take before surgery may help predict their health during recovery, says a new study.

Researchers found that older people who reported falling during the six months before heart or bowel surgery had more complications than people who reported no falls.

"It's one more marker for older adults that lets us see who is going to do poorly after an operation," Dr. Thomas Robinson, the study's lead author, said.

Falls are not necessarily the reason people do poorly after surgery, he cautioned. Instead, falls represent how frail an older person is, said Robinson, an associate professor of surgery at the University of Colorado School of Medicine in Aurora.

"When we talk about falling and we talk about older adults falling, these are people who are doing their normal activities of daily living and they fall to the ground," he said.

Current tools for estimating how well a person will fare during recovery are not specific for an older population, Robinson's team writes, so predictive signs are helpful.

For the new study, the researchers compared the recoveries of 78 people who reported a fall within the six months before a heart and bowel surgery to 157 people who reported no falls.

All were patients at the Denver Veterans Affairs Medical Center between January 2006 and October 2010. They were mostly male and all were 65 years old or older.

Researchers found that 59 percent of the people who fell before bowel surgery experienced complications afterward, compared to 25 percent of patients who hadn't fallen.

Among those who reported falls before heart surgery, 39 percent had later complications, compared to 15 percent of patients with no reported falls.

Post-surgery complications included heart attacks, pneumonia, strokes, comas, infections and blood clots.

Those who fell were also more likely to end up coming back to the hospitals within 30 days of being released, and to end up in a rehab center or nursing home.

Estimating recovery risks has many benefits, Robinson said.

Patients and families can know what to expect during recovery, such as whether they'll need to go to a nursing or rehab center. It may also convince doctors, patients and families to choose a different treatment.

"If you are a patient who is at a low risk of complication, you might opt for surgery," said Dr. Emily Finlayson, an assistant professor of surgery and health policy at the University of California, San Francisco.

On the other hand, people who are at a high risk of complication may opt for medications or other treatments besides surgery, said Finlayson, who wasn't involved in the new study.

Robinson said his team is currently studying whether it's possible to improve a person's frailty through physical activity before an operation.

"Right now we have a separate trial where we take people who are high risk and train them to survive surgery," he said.

Dr. Michael Zenilman, who wrote an editorial accompanying the new report, said the study also shows that falls are nothing to be ignored.

"A fall in an elderly patient is potentially a risk factor for frailty and even dementia," said Zenilman, vice chair and regional director of surgery at Johns Hopkins Medicine in Bethesda, Maryland.

SOURCE: http://bit.ly/17Xs2AO JAMA Surgery, online October 9, 2013.

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