Background

The objective of this study was to examine the effects of frailty based on bariatric surgery specific frailty index on Clavien-Dindo (CD) score (>=3) by procedure (Roux-en-Y gastric bypass (RYGB), Sleeve Gastrectomy (SG) and Duodenal Switch (DS) and approach (Laparoscopic (L) and Robotic (R) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database (2016-2019).

Methods

All adult patients were included. Fourteen variables of the Canadian Study of Health and Aging Frailty Index were mapped onto nine variables of MBSAQIP to derive a bariatric frailty score (0-10) 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 >=3 CD complications.

Results

The majority of patients undergoing bariatric surgery were pre-frail (55.9% in laparoscopic cohort and 57.2% in robotic cohort). There was a direct correlation between higher frailty scores and an increased incidence of >=3 CD complications in both laparoscopic and robotic cohorts, except in the L-DS group. Our results showed that the outcomes of robotic approach is dependent on frailty score in all three procedure groups (p<0.05). For pre-frail patients, the robotic approach consistently resulted in less complications compared to laparoscopic cohort.

Conclusions

This study showed that serious postoperative complications are affected by the frailty status of patients when comparing the robotic to laparoscopic approach. Using a bariatric frailty score may allow us to identify those at greater risk for complications, assist with prehabilitation and aid decision making for an appropriate surgical approach.