Objective This study aimed to explore the potential categories and characteristics of the fear of falling in the initial ambulation day among patients who underwent major abdominal surgery,analyze the factors influencing different potential categories,and propose implications for the care of such patients.Methods A total of 213 patients who u nderwent elective major abdominal surgery in the Department of Gastrointestinal Gland Surgery and Hepatobiliary Surgery in the First Affiliated Hospital of Guangxi Medical University from April to August 2023 were selected as the study subjects.The general data questionnaire and the Revised Version of the Fall Fear Scale and Patient Fall Risk Perception Scale were used to investigate the patients on the day they first got out of bed after surgery.The potential profile of the fall fear characteristics of the study subjects was analyzed,and the relevant influencing factors among different categories were explored by univariate analysis,variance analysis,and logistic regression analysis.Results A total of 202 patients who underwent major abdominal surgery were included in this study.The total score of the fear of falling when getting out of bed for the first time was(35.28±8.85).The fear of falling showed 3 potential categories:low-level fear(22.28％),medium-level fear(47.52％),and high-level fear(30.20％).A significant difference was found in the first time of getting out of bed among different types of fear(H=19.292,P＜0.001).Results of multi-factor logistic regression analysis showed that patients with high levels of personal activity factors in fall perception and those who underwent pancreatic surgery were likely to develop medium-level fear(P=0.037).Patients with high levels of perceived environmental factors,high levels of perceived personal activity factors,and low self-efficacy were likely to develop high-level fear(P＜0.05).Conclusion The fear of falling on the initial ambulation day in patients who underwent major abdominal surgery was distributed in categories,and the proportion of patients with medium and high fear levels was high.Patients'fall risk perception,self-efficacy,and surgical site are important factors influencing fear of falling.Therefore,postoperative nursing staff should focus on developing targeted health education and activity programs to reduce the level of fall fear.