Identified fall risks can be used in prevention

Investigators have identified factors that are associated with an increased risk of in-hospital falls after total hip or knee replacement surgery, and the findings can be useful to risk managers and fall prevention committees.

The study, which appears online ahead of print in the Journal of Arthroplasty, identifies risk factors using a national database of patients undergoing a joint replacement revision, explains Stavros Memtsoudis, MD, PhD, an anesthesiologist at Hospital for Special Surgery (HSS), who led the study.1 (See the story on p. 18 for details of the study.)

"This study helps doctors know which patients to look out for," Memtsoudis says. "Some studies have shown that falls occur when patients get up from their bed to go to the bathroom. While it may be unreasonable to put a helper into every room to help patients go to the bathroom, it would certainly be feasible to identify a smaller group of patients at-risk and focus efforts on them."

The study is one of the first to look into patients that suffer falls during their hospital stay after undergoing total hip or knee replacement surgery, says Alejandro Gonzalez Della Valle, MD, an orthopedic surgeon at Special Surgery, who was also involved in the study. According to published data, in-hospital falls occur in 2% to 17% of patients during short-term hospitalization. While orthopedic surgeries can put patients at risk for in-hospital falls, only two published studies to date have evaluated the risk for these types of falls in orthopedic patients.

"We detected an alarming increase in the national prevalence of this potentially preventable problem and identified a number of patient factors that were associated with an increased risk of falling during a hospital stay," he says. "The information in our study can be used by health care professionals to design or perfect in-hospital fall prevention programs."

The researchers say they hope the study will provide risk managers a smaller target to focus on for fall prevention. "If a patient comes in for revision surgery or has certain comorbidities, we know they are at increased risk," Memtsoudis explains. "Thus patients with these characteristics could be tagged and awareness of staff to especially watch out for this population could be raised."

An additional interesting study finding was that the rate of falls is increasing. The incidence over time jumped from 0.4% to 1.3% within 10 years. "It could be because of more reporting, because it is mandatory to report these falls, or because the patient population that we see — and we have more and more evidence for this — is actually getting sicker and so may, therefore, be at a greater risk."

The new research results are useful because they validate what many clinicians knew from experience or suspected, says Pamela E. Toto, PhD, OTR/L, BCG, FAOTA, an occupational therapist at the School of Health and Rehabilitation Sciences at the University of Pittsburgh in Pennsylvania. Much of what clinicians know about fall prevention is anecdotal, Toto says, so hard data is useful in establishing the need for special precautions with some patients. (See the story on p. 19 for more information on targeting at-risk patients.)

"This research confirms that the more issues you have, the more likely you are to fall," Toto says. "The more evidence we have in justifying that patients in a certain group are at high risk for falls, the more likely we are to address that risk and change those factors."


1. Memtsoudis SG, Dy CJ, Ma Y, et al. In-hospital patient falls after total joint arthroplasty incidence, demographics, and risk factors in the United States. J Arthroplasty 2011: Nov 22 (Epub ahead of print).


• Alejandro Gonzalez Della Valle, MD, Orthopedic Surgeon, Hospital for Special Surgery, New York City. Telephone: (212) 774-7124. E-mail:

• Stavros Memtsoudis, MD, PhD, Anesthesiologist, Hospital for Special Surgery, New York City. Telephone: (212) 606-1206. E-mail:

• Pamela E. Toto, PhD, OTR/L, BCG, FAOTA, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh (PA). Telephone: (412) 383-6612. E-mail: