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.
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.
Authors: Robert B Dorman; Anasooya A Abraham; Waddah B Al-Refaie; Helen M Parsons; Sayeed Ikramuddin; Elizabeth B Habermann Journal: J Gastrointest Surg Date: 2011-10-27 Impact factor: 3.452
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Gabor Abellan van Kan; Yves Rolland; Mathieu Houles; Sophie Gillette-Guyonnet; Maria Soto; Bruno Vellas Journal: Clin Geriatr Med Date: 2010-05 Impact factor: 3.076
Authors: Joseph Karam; Athanasios Tsiouris; Alexander Shepard; Vic Velanovich; Ilan Rubinfeld Journal: Ann Vasc Surg Date: 2013-05-24 Impact factor: 1.466
Authors: Peter T Hallowell; Thomas A Stellato; David A Yao; Ann Robinson; Margaret M Schuster; Kristen N Graf Journal: Am J Surg Date: 2009-03 Impact factor: 2.565
Authors: Samuel D Searle; Arnold Mitnitski; Evelyne A Gahbauer; Thomas M Gill; Kenneth Rockwood Journal: BMC Geriatr Date: 2008-09-30 Impact factor: 3.921
Authors: A C Panayi; A R Orkaby; D Sakthivel; Y Endo; D Varon; D Roh; D P Orgill; R L Neppl; H Javedan; S Bhasin; I Sinha Journal: Am J Surg Date: 2018-11-27 Impact factor: 2.565
Authors: Meera R Chappidi; Max Kates; Hiten D Patel; Jeffrey J Tosoian; Deborah R Kaye; Nikolai A Sopko; Danny Lascano; Jen-Jane Liu; James McKiernan; Trinity J Bivalacqua Journal: Urol Oncol Date: 2016-02-15 Impact factor: 3.498
Authors: Munyaradzi Chimukangara; Melissa C Helm; Matthew J Frelich; Matthew E Bosler; Lisa E Rein; Aniko Szabo; Jon C Gould Journal: Surg Endosc Date: 2016-10-03 Impact factor: 4.584
Authors: Jennifer A Kaplan; Samuel C Schecter; Stanley J Rogers; Matthew Y C Lin; Andrew M Posselt; Jonathan T Carter Journal: Surg Obes Relat Dis Date: 2015-11-04 Impact factor: 4.734