The bariatric frailty score as a superior scoring system compared to the American Society of Anesthesiologists (ASA) score in prediction of serious complications after bariatric surgery procedures

Background: The objective of this study was to compare the American Society of Anesthesiologists (ASA) score, the bariatric frailty score (BFS), and functional status of the patients who undergoing bariatric surgery in prediction of short-term outcomes characterized by Clavien-Dindo (≥ 3). Methods: Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, all adult patients who underwent sleeve gastrectomy (SG), gastric bypass (RYGB) and Duodenal switch (DS) between 2016 and 2019 were included. The bariatric frailty score (BFS) (14 variables of the Canadian Study of Health and Aging-Frailty Index were mapped onto nine variables of MBSAQIP to derive a score (0–9) which were classified as Not Frail (0), Pre-Frail (1–2), and Frail (≥ 3)), the ASA score and functional status of patients were used. Only patients with ASA score ≥ 3 were included. Logistic regression was performed and then used to derive change in AUC from the base model (including age, sex, race/ethnicity and operative time) to compare the predictability of serious complications between ASA, BFS and functional status. Results: A total of 689,198 patients were included. For SG, the bariatric frailty score showed stronger predictability value compared with the ASA and functional status, with AUCs of 0.589 for BFS, 0.579 for ASA score and 0.593 for functional status, respectively. A similar pattern was observed for RYGB. The results for DS were not consistent due to small sample size for this procedure. Conclusions: Our study showed that the BFS is slightly better at predicting CD ≥ 3 complications after bariatric surgery in comparison to more commonly used ASA score or functional status, although, none of the tested risk models performed well.