The impact of substance use disorders on postoperative falls in major noncardiac surgery: A retrospective cohort analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-03-21 DOI:10.1016/j.jclinane.2025.111814

Sandra Lee , Calvin Diep , Duminda N. Wijeysundera , Vishwathsen Karthikeyan , Karim S. Ladha

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引用次数: 0

Abstract

Background

Substance use disorders are increasing in incidence yet may be underrecognized in the surgical population. Perioperatively, these substances and/or treatments for these disorders may be acutely stopped, increasing the risk of withdrawal symptoms and accidents, such as falls. However, there have been no studies evaluating the association between substance use disorders and postoperative falls in a broad surgical population.

Methods

A retrospective cohort analysis of adults (≥18 years) undergoing a broad case mix of major elective noncardiac surgeries was conducted using the New York State Inpatient and Emergency Department Databases from 2016 to 2019. The primary exposure was the presence of one or more substance use disorders at the time of admission. The primary outcome was a postoperative fall, defined as either an in-hospital fall after surgery, or an emergency department visit for a fall within 30-days of surgical discharge. Nearest-neighbour propensity score matching was used to match patients with a substance use disorder to those without one. Logistic regression was used to estimate the association of substance use disorders with postoperative falls in the unmatched and then the matched cohorts.

Results

365,797 patients were included in this study, of which 2.12 % had an active substance use disorder. In the unmatched cohort, patients with a substance use disorder had 2.08 times the crude odds of a postoperative fall compared to their counterparts (95 % CI: 1.55 to 2.80, p < 0.001). In the matched cohort of 15,530 patients, a substance use disorder was also associated with an increased risk of 30-day falls (OR 1.71, 95 % CI 1.06 to 2.75, p = 0.028).

Discussion

Approximately 2 % of adults undergoing major elective noncardiac surgery had a substance use disorder. Patients with a substance use disorder had increased risks of postoperative falls. This study identified a potentially high-risk group of patients and highlights a continued need for robust screening and management of various substance use disorders in the perioperative period.

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药物使用障碍对重大非心脏手术术后跌倒的影响：回顾性队列分析

背景：药物使用障碍的发病率正在增加，但在外科人群中可能未得到充分认识。围手术期，这些药物和/或对这些疾病的治疗可能会突然停止，增加戒断症状和事故（如跌倒）的风险。然而，在广泛的手术人群中，还没有研究评估药物使用障碍与术后跌倒之间的关系。方法使用2016年至2019年纽约州住院和急诊科数据库，对接受重大选择性非心脏手术的成年人（≥18岁）进行回顾性队列分析。主要暴露是入院时存在一种或多种物质使用障碍。主要终点是术后跌倒，定义为手术后住院跌倒，或手术出院后30天内急诊跌倒。最近邻倾向评分匹配用于匹配有物质使用障碍的患者和没有物质使用障碍的患者。在未匹配队列和匹配队列中使用Logistic回归来估计药物使用障碍与术后跌倒的关系。结果共纳入365,797例患者，其中2.12%存在活动性物质使用障碍。在未匹配的队列中，物质使用障碍患者术后跌倒的粗概率是对照组的2.08倍(95% CI: 1.55至2.80,p <；0.001)。在15530名患者的匹配队列中，物质使用障碍也与30天跌倒风险增加相关（OR 1.71, 95% CI 1.06至2.75,p = 0.028）。大约2%的接受重大选择性非心脏手术的成年人有物质使用障碍。有物质使用障碍的患者术后跌倒的风险增加。这项研究确定了一个潜在的高危患者群体，并强调了在围手术期对各种物质使用障碍进行强有力的筛查和管理的持续需求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.