Surgery for Obesity and Related Diseases · Oct 10, 2025

Modified bariatric frailty score to predict postoperative outcomes in elderly patients following sleeve gastrectomy and Roux-en-Y gastric bypass

By Sebastian R, Zevallos A, Tuesta O et al.

BACKGROUND: Elderly patients undergo bariatric surgery less frequently than younger patients due to several factors such as increased complication risk. Obesity exacerbates frailty among elderly patients through sarcopenia and metabolic dysfunction. Therefore, specific preoperative risk assessment in elderly patients is crucial. OBJECTIVES: We created the modified Bariatric Frailty Score (mBFS) and compared the 30-day outcomes between low versus high mBFS in elderly patients after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). SETTING: 2015-2022 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. METHODS: Patients aged ≥ 60 years who underwent SG and RYGB were included. 14 variables of the Canadian Study of Health and Aging-Frailty Index were mapped onto 9 variables of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (each component equals 1 point). Correlations and multivariate logistical regression analysis were performed between mBFS and 7 postoperative outcomes (nonhome discharge, mortality, prolonged hospital stay, intensive care unit admissions, cardiac complications, pulmonary complications, and renal complications). Finally, a propensity score matching between low mBFS (0-4) and high mBFS (5-9) was performed for SG and RYGB. RESULTS: A total of 90,239 and 40,272 patients were included for SG and RYGB, respectively. The increasing mBFS was strongly correlated with linear regression. In the multivariate analysis, scores of 5, 6, 7, and 8 strongly predicted the 7 postoperative outcomes of interest. After the propensity score matching, the matched cohorts for SG and RYGB were 3337 and 1655, respectively. A high mBFS (5-9) was associated with an increased rate of postoperative complications in the SG and RYGB groups. CONCLUSIONS: Our mBFS is a better predictor of nonhome discharge, prolonged hospital stays, 30-day mortality, unplanned intensive care unit admissions, and cardiac, pulmonary, and renal complications than the American Society of Anesthesiologists score of III, American Society of Anesthesiologists score of IV-V, renal insufficiency, or smoker status. Our study validated the cumulative deficit theory in elderly bariatric surgery patients.

doi.org/10.1016/j.soard.2025.10.002PubMed 41188097Biomarkers