Background

Frailty is associated with increased postoperative complications following metabolic and bariatric surgery (MBS). The impact of frailty on weight loss outcomes after MBS is unknown.

Methods

Determine the impact of patient frailty on percent excess BMI loss (%EBMIL) up to 5 years after MBS. SettingVeterans Affairs medical center (VAMC). Method Retrospective analysis of a prospective database of consecutive bariatric operations performed at a single VAMC. Frailty was calculated using the Bariatric Frailty Score (BFS), from the Canadian Study of Health and Aging-Frailty Index (CSHA-FI). %EBMIL in 'frail' patients (BFS>4) was compared with 'non-frail' patients (BFS<3) at 1, 2, and 5 years, postoperatively. Student's t-test was used to compare means; p<0.05 was considered significant.

Results

Of 248 patients, 45 underwent RYGB (18%), 203 underwent SG (82%). Preoperatively, 59 patients were frail (24%), 189 patients were non-frail (76%). Follow up rate at 5 years was 96%.. After SG, %EBMIL was 40% in frail patients at 1 year vs. 53% in non-frail patients (p<0.05), 37% vs. 48% (p<0.05) at 2 years, 29% vs. 40% at 5 years (p<0.05). After RYGB, %EBMIL was 57% at 1 year in frail patients vs. 78% in non-frail patients (p<0.05), 55% vs. 77% (p=0.2) at 2 years, and 50% vs. 62% (P = 0.2) at 5 years.

Conclusions

Frailty is associated with significantly less %EBMIL up to 5 years after SG. A similar trend is seen after RYGB. Frailty assessment should be part of MBS preoperative evaluation, can help manage patient expectations, and guide post-operative care.