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Assessing Risk of Critical Care Complications and Mortality in the Elective Bariatric Surgery Population Using a Modified Frailty Index

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Abstract

Background

The rate of surgical complications from bariatric procedures remains low despite an increase in volume. When serious complications occur, they are associated with an increased risk of mortality. The aim of this study is to determine if frail bariatric patients have an increased rate of Clavien level 4 and 5 complications. This study was conducted in participating hospitals in the National Surgical Quality Improvement Program (NSQIP).

Methods

The NSQIP participant use files were used to identify 104,952 patients undergoing elective bariatric procedures from 2005 to 2012. A previously described modified frailty index (mFI) was calculated based on available NSQIP variables, with a higher index suggesting more frail patients. Postoperative adverse events were stratified to Clavien levels 4 and 5 utilizing a pre-existing mapping scheme.

Results

Overall, 1 % of patients undergoing elective bariatric surgery experienced Clavien level 4 complications, and 0.2 % experienced a Clavien level 5 complication (mortality). Univariate analysis demonstrated that frailty was significant for both Clavien level 4 and 5 complications (p < 0.001). The mean mFI for those with Clavien level 4 complications, 0.15, was significantly higher than those without Clavien 4 complications, 0.09 (p < 0.001). Those experiencing mortality had a mean mFI of 0.17 compared to a mean mFI of 0.09 in those without mortality (p < 0.001). Frailty retained the highest odds ratio for both Clavien 4 and 5 complications in multivariate analysis compared to American Society of Anesthesiologist (ASA) class, age, sex, body mass index (BMI), and procedure type.

Conclusions

Frailty may be used during patient selection to stratify bariatric surgery patients at high risk for critical care level complications.

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Acknowledgements

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Conflict of Interest

Nina Kolbe DO, Arthur Carlin MD, Stephanie Bakey DO, Lisa Louwers MD, Mathilda Horst MD, and Ilan Rubinfeld MD have no conflicts of interest to disclose.

Ethical Approval

For this type of retrospective study, formal consent is not required.

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Authors and Affiliations

  1. Department of Acute Care Surgery/ Surgical Critical Care, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA

    Nina Kolbe, Stephanie Bakey, Lisa Louwers, H. Mathilda Horst & Ilan Rubinfeld

  2. Department of General Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA

    Arthur M. Carlin

Authors
  1. Nina Kolbe
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  2. Arthur M. Carlin
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  3. Stephanie Bakey
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  4. Lisa Louwers
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  5. H. Mathilda Horst
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  6. Ilan Rubinfeld
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Corresponding author

Correspondence to Nina Kolbe.

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Kolbe, N., Carlin, A.M., Bakey, S. et al. Assessing Risk of Critical Care Complications and Mortality in the Elective Bariatric Surgery Population Using a Modified Frailty Index. OBES SURG 25, 1401–1407 (2015). https://doi.org/10.1007/s11695-014-1532-3

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  • DOI: https://doi.org/10.1007/s11695-014-1532-3

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