Preoperative patient education reduces in-hospital falls after total knee arthroplasty

Abstract

Background: Inpatient hospital falls after orthopaedic surgery represent a major problem, with rates of about one to three falls per 1000 patient days. These falls result in substantial morbidity for the patient and liability for the institution.

Questions/purposes: We determined whether preoperative patient education reduced the rate of in-hospital falls after primary TKA and documented the circumstances and the injuries resulting from the falls.

Patients and methods: We reviewed data from all 244 patients who underwent primary TKA at a single institution between March and November 2009. Seventy-two patients of one surgeon were enrolled in a preoperative nurse-led education program. This group was compared with a control group of 172 patients who concurrently underwent TKA at the same institution but did not receive preoperative education.

Results: More control patients had in-hospital falls than those in the education group: seven (one of whom had two falls) of 172 (4%) versus none of 72 (0%), respectively. Three of the eight falls resulted in a serious injury, including one wound dehiscence and one wound hematoma that both required repeat surgery and one clavicle fracture.

Conclusions: Inpatient falls after TKA may be associated with major complications. Our preoperative patient education reduced these falls and is now mandatory for patients undergoing TKA at our institution.