A frailty index and the impact of frailty on postoperative outcomes in older patients after bariatric surgery

Background: The prognostic value of frailty in the elderly surgical population has been well studied across surgical specialties. However, no studies have yet explored the effects of frailty across the full spectrum of adverse events after bariatric surgery. Objectives: To study the impact of index-frailty on the full range of adverse short-term outcomes after bariatric surgery. Methods: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data file for 2016 was used. Descriptive analyses, univariable, and multivariable regression models, assessed for discriminative and predictive capacities, were used to assess the effects of frailty on Clavien-Dindo categorized adverse outcomes within 30 days of bariatric surgery. Frailty index was modified from Canadian Study of Health and Aging Frailty Index. Setting: Data pooled from American Society for Bariatric Surgery–accredited bariatric surgery centers, United States. Results: A total of 21,426 patients aged ≥60 undergoing primary bariatric procedures were included. The prevalence of frailty as defined by the modified frailty index was 44.4%. Frail status was independently associated with higher odds of 30-day adverse events (Clavien-Dindo grades I, II, III, IV, and V). Frailty scores had weakly positive correlations with increasing age and increasing body mass index in the bariatric patients. Conclusion: Frailty can be used as a risk stratification modality for patients before bariatric surgery. Further research should focus on exploring the relationship between obesity and frailty and the effects of weight loss on frailty status of bariatric patients.