The impact of frailty on serious complications after bariatric surgery: a comparison between robotic and laparoscopic approach.

BACKGROUND

Frailty is a state of reduced physiologic capacity, and our group has created a bariatric frailty index using 9 variables from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. We found that frailty scores had weakly positive correlations with increasing age and body mass index in bariatric patients.

OBJECTIVE

To examine the effect of frailty and pre-frailty on Clavien-Dindo (CD) ≥III grade complications after bariatric surgery for all adults as well as outcomes of surgical approach using the MBSAQIP database (2016-2019).

SETTING

Data pooled from American Society for Bariatric Surgery-accredited bariatric surgery centers, United States.

METHODS

All adult patients were included. Fourteen variables of the Canadian Study of Health and Aging Frailty Index were mapped onto 9 variables of MBSAQIP to derive a bariatric frailty score (0-9) which were classified as Not frail (0), pre-frail (1-2), and frail (≥3). Logistic regression was performed to evaluate the effects of frailty on CD ≥III grade complications.

RESULTS

Most patients undergoing bariatric surgery were pre-frail (56% versus not frail 33.6% vs frail 10.3%). There was a positive association between greater frailty scores and a greater frequency of CD ≥III grade complications in both laparoscopic and robotic cohorts. Regardless of surgical approach or operation, patients who were classified as pre-frail and frail had greater frequency of serious complications compared with patients classified as not frail.

CONCLUSIONS

Using a bariatric frailty score to identify patients who are pre-frail and frail may assist with prehabilitation before bariatric surgery and assist with decision-making for surgical approach.