1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: firstname.lastname@example.org.
2Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: email@example.com.
3Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: firstname.lastname@example.org.
BACKGROUND & AIMS:
Reducing or eliminating falls are a focus of patient safety programs as well as health policy. Falls are tied to hospital reimbursement. However, little is known about the risk of falls among hospitalized patients with cirrhosis or factors that affect risk of falling.
We conducted a retrospective cohort study of inpatients with cirrhosis from 2010 to 2013 at a liver transplant center. Our primary aim was to determine the clinical factors associated with falls and fall-related injuries for patients with cirrhosis. Our secondary aim was to describe the rate-ratio of falls and fall-related injuries among patients with cirrhosis compared to general medical inpatients.
During the study period, there were 1749 admissions to the liver service; 55 (3.1%) resulted in falls. Patients who fell were more likely to have received benzodiazepines (50.9% vs 167%; P<.0001) and anti-psychotic agents (30.9% vs 7.3%; P<.0001). After adjusting for hepatic encephalopathy, the respective odds of a fall after benzodiazepine or antipsychotic exposure were 6.59 (95% confidence interval [CI], 3.76-11.59) and 3.72 (95% CI, 1.90-7.06).The adjusted risk of a fall-related injury was also significantly associated with benzodiazepine and antipsychotic agents, with respective odds ratios of 3.45 (95% CI, 1.39-8.23) and 3.42 (95% CI, 1.09-8.99). Fall-related injuries occurred at a rate of 1.70/1000 patient-days for patients with cirrhosis, vs 0.5/1000 patient-days for patients in the general medical service. Accordingly, the rate ratio for a fall-related injury among patients with cirrhosis was 3.37 (95% CI, 1.99-5.72; P<.0001).
Psychoactive medications are associated with an increased adjusted risk of falls and fall-related injuries in hospitalized patients with cirrhosis.