Background

Preoperative patient frailty (i.e., aging-related functional decline across multiple physiological systems) has been linked to greater perioperative complications following metabolic and bariatric surgery (MBS). This study evaluated whether frailty is also adversely related to weight loss response after MBS.ObjectiveEvaluate whether preoperative patient frailty predicts 1-year weight loss non-response after primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

Methods

The Bariatric Frailty Score (BFS), an adapted version of the Canadian Study of Health and Aging-Frailty Index based on 10 variables from MBSAQIP, assessed degree of frailty based on number of deficits (i.e., 0-10). Non-response to MBS was defined as <20% and <30% TWL at 1-year following SG and RYGB, respectively. Multiple linear and logistic regression models evaluated associations of preoperative BFS score with %TWL and %TWL response thresholds, respectively.

Results

Participants (n=1574; 78.9% female, 28.3% non-white race, mean age 45+-12yr; 67% SG) had a BFS of 1.6+-1.3 (range=0-7). Overall, higher BFS related to lower %TWL after SG and RYGB (ß=-0.11, p<0.001). Compared to participants with 1 or no deficits (BFS score <=1; n=785, 49.9%), those with multiple deficits (BFS score >=2; n=789, 50.1%) had higher odds of being a weight loss non-responder after SG (OR=0.53, 95%CI: 0.39-0.71, p<.001) and RYGB (OR=0.46, 95%CI: 0.30-0.69, p<.001).

Conclusions

Increasing preoperative frailty is associated with 47%-54% greater risk of weight loss nonresponse after MBS. Findings point to the need for increased frailty screening and appropriate adjunctive interventions (i.e., exercise, nutrition, and cognitive) to improve frailty status and MBS outcomes.