Medication burden and inpatient falls in orthopaedic inpatients: a retrospective propensity score-matched study

Inpatient falls are a common complication in orthopaedic patients; however, their risk factors and temporal patterns remain incompletely understood. This study aimed to identify factors associated with inpatient falls and to characterize the timing and circumstances of falls during hospitalization.

A retrospective cohort study was conducted including 1,617 consecutive orthopaedic inpatients. Univariate logistic regression analysis was performed in the full cohort using variables available for all patients. Propensity score matching (1:1) was then performed using age, sex, and body mass index. Additional clinical variables, including medication-related factors, were evaluated in the matched cohort. Multivariate logistic regression analysis was performed to identify independent risk factors. Fall characteristics, including timing and location, were descriptively analyzed.

Among 1,617 patients, 48 (3.0%) experienced falls during hospitalization. In the full cohort, age was significantly associated with falls, whereas other baseline variables were not. Propensity score matching yielded 48 matched pairs with well-balanced baseline characteristics. In the matched cohort, the number of medications was significantly higher in the fall group and remained independently associated with falls (adjusted OR 1.14, 95% CI 1.01-1.29, p = 0.036). Falls most frequently occurred in patient rooms (56.3%) and were observed across all time periods. Falls occurred more frequently in the early phase of hospitalization, with 70.8% occurring within the first 14 days.

A higher number of medications was independently associated with inpatient falls in orthopaedic patients. Falls occurred most frequently in the early phase of hospitalization, particularly on the day of admission and the following day. These findings suggest that early targeted interventions and careful medication management may help reduce inpatient falls.