Incidence and Risk Factors of Falling in the Postoperative Lower Limb Amputee While on the Surgical Ward

Abstract

Objective To determine the incidence and risk factors of falling among amputees during the postoperative time on the surgical ward. Design Retrospective cohort. Setting Three tertiary acute care hospitals. Patients Subjects aged 18 years or older undergoing either a primary or revision amputation at the transtibial, knee disarticulation, or transfemoral levels. Subjects were excluded if they underwent bilateral amputations. A total of 466 charts were identified, and 370 subjects were included in the analysis. Main Outcome Measurements All outcome measurements were devised before data collection. The primary outcome variable was the presence of at least one fall. Details regarding falls, including the date, time, and location of the first fall, were recorded. In addition, the total number of falls and any associated injuries were documented. Secondary outcome variables included type and number of medical comorbidities, cognitive deficits, and regular use of specific medications. Results Sixty‐one of 370 subjects fell at least once, giving an incidence of 16.5% (95% confidence interval [95% CI] 12.7%‐20.3%). No difference was noted between the fall and no fall groups for gender, mean age, number of regular medications, and number of medical comorbidities. The fall group demonstrated a significantly longer length of stay (difference of means 32.5 days, 95% CI 17.4‐47.5, P < .001). Injuries were sustained in 60.7% of those who fell. Multiple logistic regression analysis identified the major risk factors for falling as dysvascular etiology (odds ratio [OR] 2.418, 95% CI 1.043‐5.606), transtibial level (OR 2.127, 95% CI 1.050‐4.309), and right‐sided amputation (OR 1.933, 95% CI 1.073‐3.483). Conclusions Falls and associated injuries occur commonly in the postoperative lower limb amputee on the surgical ward. Risk factors for falling include dysvascular etiology, transtibial level, and right‐sided amputation. Further studies are required to characterize the mechanisms of falling in this patient population and to develop appropriate fall‐prevention strategies.

The validity of forceplate data as a measure of rapid and targeted volitional movements of the centre of mass in transtibial prosthesis users

“…These individuals must coordinate whole-body movements despite the lack of critical structures, such as the foot, ankle, and more proximal joints. Balance confidence is also decreased in prosthesis users [4,5] and these individuals fall more frequently than age matched controls [6,7].…”

Does long-distance walking improve or deteriorate walking stability of transtibial amputees?

“…Approximately half of the lower-limb amputees have experienced a fall at least once within 12 months (Miller et al, 2001). It was also reported that 16.5% of the amputees experienced falls in the hospital and 60.7% of them got injured because of the falls (Yu et al, 2010). One plausible reason explaining the high incidence of falls is that they have poor balance due to the loss of active plantarflexion and dorsiflexion (Hak et al, 2013;Vanicek et al, 2009), which cannot be compensated by prostheses.…”

Risk Factors for Falls in Individuals With Lower Extremity Amputations During the Pre‐Prosthetic Phase: A Retrospective Cohort Study

“…Although falls are common in individuals with LLAs, it is important to note that the occurrence of falls varies across the care continuum (eg, acute surgical ward after amputation, inpatient rehabilitation, and community living after rehabilitation) . Prospective studies have demonstrated that the percentage of people falling varies from 20.5% in acute hospitals, 35% in inpatient rehabilitation programs, to a high of 42.5% in the first 6 months after discharge from inpatient rehabilitation . Even years after successful completion of inpatient rehabilitation programs, more than half of community‐dwelling adults with an LLA fall at least once a year, with 33% experiencing two or more falls .…”

“…Consequences of falls also differ across the phases of care. Falls during inpatient rehabilitation can result in death, injury, a longer length of hospital stay, and greater health care costs . In addition, consequences of falls for community dwellers include limb fracture, fear of falling, lack of prosthesis use, and social withdrawal compared to individuals with LLA who do not fall .…”

“…One area with limited research is the time frame from the amputation surgery to admission to an inpatient rehabilitation program . Although Yu et al evaluated falls within the acute care hospital setting after the amputation, it is important to appreciate that individuals with a new LLA may not transfer directly from the acute care hospital setting to an inpatient prosthesis rehabilitation program. It is important to note also that individuals with an amputation may be home up to 16 weeks between the time of amputation and admission to an inpatient or outpatient prosthetic rehabilitation program .…”