Though postoperative epidural analgesia can provide significant benefits for abdominal and thoracic surgery patients, it may also be linked with decreased muscle strength, sympathetic tone, and proprioception, and could contribute to falls. Researchers from the University of Texas Southwestern Medical Center Department of Anesthesiology and Pain Management studied the effects of epidural analgesia on the incidence of inpatient falls. They employed a retrospective case-control design to evaluate data from the Nationwide Inpatient Sample for 2007 through 2011. Data from 42,658 thoracic and 54,974 upper abdominal surgery patients were analyzed.
The overall incidence of falls in thoracic and abdominal surgical patients was 6.54% and 4.95%, respectively. In both groups, falls incidence increased over the study period. For the final study year, the respective incidence of falls in thoracic and abdominal surgery patients was 8.11% and 6.07%. Applying logistic regression analyses and McNemar’s tests showed no association between epidural analgesia and inpatient falls. The relative risk ratios for the thoracic and abdominal surgery groups were 1.18 (95% CI, 0.95 to 1.47, P=0.144) and 0.84 (95% CI, 0.64 to 1.09, P=0.220), respectively. The authors concluded that postoperative epidural analgesia did not influence inpatient risk of falling in these surgery patients.
Elsharydah A, Williams TM, Rosero EB, Joshi GP. Epidural analgesia does not increase the rate of inpatient falls after major abdominal and thoracic surgery: a retrospective case-control study. Can J Anaesth. 2016;63(5):544-551.