Association of preoperative frailty with suboptimal weight loss response among patients undergoing metabolic and bariatric surgery

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

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). Suboptimal response to MBS was defined as < 20% and < 30% percentage total weight loss (%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.

Patients (n = 1574; 78.9% female, 28.3% non-white, mean age 45 ± 12 year; 67% SG) had a mean BFS of 1.6 ± 1.3 (range = 0–7). Overall, higher BFS related to lower %TWL after SG and RYGB (ß = − 0.12 and ß = − 0.17, respectively, p = 0.001). Compared to patients with 0–1 deficits (BFS score ≤ 1; n = 785, 49.9%), those with multiple deficits (BFS score ≥ 2; n = 789, 50.1%) had higher odds of suboptimal weight loss response after SG (OR 1.88, 95% CI 1.40–2.52, p < 0.001) and RYGB (OR 2.18, 95% CI 1.43–3.32, p < 0.001).

Having multiple preoperative frailty deficits is associated with higher odds of suboptimal weight loss response after MBS. These findings point to the need for increased frailty screening and appropriate adjunctive interventions (i.e., exercise, nutrition, and cognitive), as these interventions may improve frailty status and MBS outcomes.