Inpatient Falls Are on the Rise Following Anterior Cervical Discectomy and Fusion: Risk Factors Associated With This Potentially Devastating “Never Event”

Introduction: Patients undergoing anterior cervical discectomy and fusion (ACDF) may be at risk for inpatient falls (IPFs) related to surgery, neurologic symptoms or altered mobility. Such IPFs should be a preventable occurrence, yet no studies have investigated the incidence, trends, and factors associated with IPFs for patients undergoing ACDF.

Methods: Adult patients who underwent single or multilevel ACDF were identified between 2010-2022 from PearlDiver database. Those who suffered an IPF were subsequently identified. Annual trend data was analyzed, and various risk factors were assessed for their correlation with IPFs by multivariable logistic regression. To determine the association between IPF and length of stay (LOS), patients with IPF, relative to without, were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) and compared by multivariable logistic regression.

Results: 294,165 ACDF patients were identified, with 5,548 (1.9%) sustaining an IPF. 2010-2022 annual incidence of IPFs increased from 1.1% to 4.8% (p < 0.001). Independent predictors of an IPF were: hospital acquired delirium (odds ratio [OR] 4.50), prior falls (OR 3.38), hospital acquired psychosis (OR 3.17), alcohol use disorder (OR 2.68), cervical myelopathy (relative to radiculopathy) (OR 2.66), low income (OR 1.85), dementia (OR 1.77), BMI < 18.5 (OR 1.67), multi-level ACDF (OR 1.43), prior cervical surgery (OR 1.41), male sex (OR 1.37), Medicaid insurance (OR 1.34), older age (OR 1.33), patients in the Northeastern United States (OR 1.15), and BMI >30 (OR 1.15) (p < 0.001 for all). Those with IPFs demonstrated longer LOS of 7+ days (OR 6.78), 6-7 days (OR 3.85), and 4-5 days (OR 2.63) (p < 0.001 for all).

Conclusion : There is an increasing annual incidence of IPF following ACDF. Various factors associated with IPFs are potentially modifiable and may help reduce LOS and patient morbidity. Optimizing care pathways for high-risk patients and refinement of fall prevention programs are needed.