Jakub Dros1, Tomasz Stefura1, Artur Kacprzyk1, Katarzyna Chlopas1, Magdalena Pisarska, MD2, Michal Wysocki, MD2, Michal Pedziwiatr, MD, PhD2, Andrzej Budzynski, MD, PhD, Professor2, Piotr Major, MD, PhD2. 1Students’ Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland, 22nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
Introduction: Obesity and aging are associated with declines in organ functions and constitute a marker of frailty. A modified frailty index (MFI) is a confirmed tool predicting postoperative morbidity and mortality, but its usefulness in the field of bariatric surgery has not been sufficiently investigated. As the population ages and more elderly patients seek bariatric procedures, it is essential to evaluate the method which may potentially improve quality and efficacy of the treatment.
Objectives: To assess the usefulness of MFI as a predictor of short- and long-term outcomes of bariatric surgery.
Methods: The retrospective analysis was conducted among 731 patients who underwent laparoscopic bariatric surgery during eight-year period. MFI was calculated using 11 variables defined in the National Surgical Quality Improvement Program of the American College of Surgeons. Primary endpoints of the study include intra- and postoperative parameters, secondary endpoints – long-term effects of bariatric treatment after one-year follow-up. The correlations between MFI and surgical outcomes were assessed. Additionally, a cutoff MFI score of 0.18 and above classified patients as “frail”.
Results: Increasing MFI was not significantly associated with longer operative time (p=0.41 for sleeve gastrectomy, p=0.88 for Roux-and-Y gastric bypass), higher rates of intraoperative adverse events (p=0.36), postoperative complications (p=0.08), reoperations (p=0.16), readmissions (p=0.21) and longer hospital stay (p=0.25). Multivariate logistic regression models adjusted for relevant intergroup baseline differences did not show increased risks of negative intra- and postoperative outcomes in “frail” patients. Increasing MFI was negatively correlated with effects of bariatric treatment in terms of percentage of weight loss (p=0.02) and percentage of excessive weight loss (p<0.01), but not percentage of excessive body-mass index loss (p=0.09).
Conclusion: Estimation of MFI in bariatric patients does not constitute a method predicting intra- and postoperative outcomes of the surgery. However, high MFI is associated with inferior long-term effects of bariatric treatment in terms of weight loss.
Keywords: bariatric surgery, modified frailty index, postoperative complications
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94153
Program Number: P124
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster