Inpatient falls after shoulder arthroplasty

Abstract

Background: Patient falls are one of the most commonly reported safety incidents in hospitals and an important cause of harm. Despite growing interest in postoperative fall prevention, data on the extent and correlates of falls among elective orthopedic inpatients are sparse and confined to lower limb arthroplasty. We evaluated inpatient fall trends after elective shoulder arthroplasty and identified patient and hospital characteristics associated with the occurrence of falls.

Methods: We used discharge records from the Nationwide Inpatient Sample (2002-2011). Temporal trends were assessed, and multivariate logistic regression modeling was used to characterize factors associated with inpatient falls.

Results: The rate of in-hospital falls increased from 0% in 2002 to 1.7% in 2011, despite a downward trend in length of stay (P < .001). Patient characteristics associated with the occurrence of falls included older age, Hispanic race/ethnicity, and lower household income. In decreasing order of magnitude, the comorbidities associated with falls were fluid/electrolyte disorder, opioid use disorder, malnutrition/weight loss, chronic anemia, visual impairment, nonopioid drug use disorder, congestive heart failure, and hearing impairment. Falls were more likely to occur at teaching hospitals and in regions other than the Northeast.

Conclusions: The rate of in-hospital falls after shoulder arthroplasty is increasing despite shorter stays. Many of the identified factors associated with inpatient falls after shoulder arthroplasty are modifiable, either by better preoperative planning and care coordination, by optimized medical management, or by improved patient education and engagement.

Keywords: Falls; Nationwide Inpatient Sample; epidemiology; never events; outcomes; patient safety; shoulder arthroplasty.