Abstract Background Frailty has emerged as a crucial factor influencing postoperative risk among older adults undergoing bariatric surgery. The Bariatric Frailty Index (bFI), specifically designed and validated in a national multicenter population of patients aged 60 years and above, utilizes nine preoperative variables to quantify individual frailty risk. In this single-center retrospective study, we aimed to evaluate the implementation and predictive utility of the bFI in our local bariatric cohort. Methods We reviewed the medical records of 231 patients aged 60 years or older who underwent primary bariatric surgery at our institution. Preoperative frailty status was assessed using the bFI, with a cut-off of 0.27 to define frail individuals, mirroring the threshold established in the original validation work. Demographic, anthropometric, and clinical data were collected, along with 30-day postoperative outcomes, including complications (categorized by the Clavien-Dindo classification), readmissions, and length of hospital stay. Statistical analysis was used to compare outcomes between frail and non-frail patients, including an assessment of independent risk factors. Results In our cohort, the mean age was 62.5 years (range 60–78), with a mean BMI of 41.9 ± 4.8 kg/m2. Frailty (bFI 0.27) was identified in 72 patients (31.2%), while 159 (68.8%) were non-frail. Compared to non-frail patients, frail individuals demonstrated higher rates of 30-day postoperative complications (13.9% versus 10.7%), readmissions (1.4% versus 2.5%), and serious complications (Clavien-Dindo grade 3b: 2.8% versus 2.5%). Although these differences did not reach statistical significance, likely due to the sample size, the bFI showed a strong association with adverse events in logistic regression analysis, and smoking status was also found to be associated with an increased risk. The prevalence of frailty in our population was lower than the 44.4% previously reported in the multicenter validation cohort, suggesting possible differences in case selection or referral patterns. Routine frailty assessment using the bFI was feasible and readily integrated into our preoperative workflow. Adoption of the bFI facilitated objective risk stratification and informed multidisciplinary decision-making, especially in complex or borderline surgical candidates. Conclusion As our real-world data confirm the tool’s practicality and highlight trends toward increased complications among frail patients, these findings support the wider implementation and prospective validation of the tool in diverse clinical settings. Further research should explore the role of frailty mitigation strategies and the impact of bFI-based pathways on both short- and long-term outcomes in this rapidly growing population.
Sousa et al. (Thu,) studied this question.