Preoperative functional health status is a predictor of short-term postoperative morbidity and mortality after bariatric surgery

Published:February 15, 2019DOI:


      • FHS is a predictor of increased morbidity and mortality after bariatric surgery.
      • Quality initiatives are needed to improve outcomes in this patient group.



      Functional health status (FHS) is the ability to perform activities of daily living without caregiver assistance.


      The primary aim of this study was to determine the impact of impaired preoperative FHS on morbidity and mortality within 30 days of bariatric surgery.


      Academic medical center in the United States.


      The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 data set was queried for primary minimally invasive bariatric procedures. The demographic characteristics and perioperative details of patients who were functionally independent were compared with patients with impaired FHS. Multivariable logistic regression analysis was performed to determine the odds of developing a perioperative complication or death for patients with impaired functional health.


      Of patients, 1515 (1.0%) were reported as having impaired FHS and 147,195 patients (99.0%) were independent before surgery. Patients with impaired FHS experienced significantly longer length of hospital stays (2.4 versus 1.8 d; P < .0001), a higher morbidity (adjusted odds ratio 1.5; P <0.0001), and higher mortality (adjusted odds ratio 2.1; P < .0001). Impaired FHS resulted in significantly increased rate of unplanned admissions to the intensive care unit, interventions, reoperations, and readmissions within 30 days of surgery.


      Patients with impaired FHS preoperatively have a significantly increased risk of short-term morbidity and mortality after bariatric surgery. The results of this study highlight the importance of establishing quality initiatives focused on improving short-term outcomes for patients with impaired functional health status.

      Graphical abstract


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Vincent G.
        • Velkott V.
        The next four decades: the older population in the united states: 2010 to 2050 [monograph on the Internet].
        US Census Bureau, Suitland2010 ([Cited 2019, January]. Available from:)
        • Finkelstein E.A.
        • Khavjou O.A.
        • Thompson H.
        • et al.
        Obesity and severe obesity forecasts through 2030.
        Am J Prev Med. 2012; 42: 563-570
        • Giordano S.
        • Victorzon M.
        Bariatric surgery in elderly patients: a systematic review.
        Clin Interv Aging. 2015; 10: 1627-1635
        • Robinson T.N.
        • Eiseman B.
        • Wallace J.I.
        • et al.
        Redefining geriatric preoperative assessment using frailty, disability and co-morbidity.
        Ann Surg. 2009; 250: 449-455
        • Makary M.A.
        • Segev D.L.
        • Pronovost P.J.
        • et al.
        Frailty as a predictor of surgical outcomes in older patients.
        J Am Coll Surg. 2010; 210: 901-908
        • Kim S.W.
        • Han H.S.
        • Jung H.W.
        • et al.
        Multidimensional frailty score for the prediction of postoperative mortality risk.
        JAMA Surg. 2014; 149: 633-640
        • Saxton A.
        • Velanovich V.
        Preoperative frailty and quality of life as predictors of postoperative complications.
        Ann Surg. 2011; 253: 1223-1229
        • Chimukangara M.
        • Frelich M.J.
        • Bosler M.E.
        • Rein L.E.
        • Szabo A.
        • Gould J.C.
        The impact of frailty on outcomes of paraesophageal hernia repair.
        J Surg Res. 2016; 202: 259-266
        • Dasgupta M.
        • Rolfson D.B.
        • Stolee P.
        • Borrie M.J.
        • Speechley M.
        Frailty is associated with postoperative complications in older adults with medical problems.
        Arch Gerontol Geriatr. 2009; 48: 78-83
        • DeMaria E.J.
        • Portenier D.
        • Wolfe L.
        Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass.
        Surg Obes Relat Dis. 2007; 3: 134-140
        • DeMaria E.J.
        • Murr M.
        • Byrne T.K.
        • et al.
        Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity.
        Ann Surg. 2007; 246 (discussion 583–74): 578-582
        • MBSAQIP 2017 PUF User Guide
        ([Updated 2018, October; cited 2018, November]. Available from:)
        • Albright E.L.
        • Davenport D.L.
        • Roth J.S.
        Preoperative functional health status impacts outcomes after ventral hernia repair.
        Am Surg. 2012; 78: 230-234
        • de la Fuente S.G.
        • Bennett K.M.
        • Scarborough J.E.
        Functional status determines postoperative outcomes in elderly patients undergoing hepatic resections.
        J Surg Oncol. 2013; 107: 865-870
        • Crawford R.S.
        • Cambria R.P.
        • Abularrage C.J.
        • et al.
        Preoperative functional status predicts perioperative outcomes after infrainguinal bypass surgery.
        J Vasc Surg. 2010; 51 (discussion 358–9): 351-358
        • Gebhart A.
        • Young M.T.
        • Nguyen N.T.
        Bariatric surgery in the elderly: 2009-2013.
        Surg Obes Relat Dis. 2015; 11: 393-398
        • Flum D.R.
        • Salem L.
        • Elrod J.A.
        • Dellinger E.P.
        • Cheadle A.
        • Chan L.
        Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures.
        JAMA. 2005; 294: 1903-1908
        • Hothem Z.
        • Baker D.
        • Jenkins C.S.
        • et al.
        Predictors of readmission in nonagenarians: analysis of the American College of Surgeons National Surgical Quality Improvement Project dataset.
        J Surg Res. 2017; 213: 32-38
        • Scarborough J.E.
        • Bennett K.M.
        • Englum B.R.
        • Pappas T.N.
        • Lagoo-Deenadayalan S.A.
        The impact of functional dependency on outcomes after complex general and vascular surgery.
        Ann Surg. 2015; 261: 432-437
        • Wahl T.S.
        • Graham L.A.
        • Hawn M.T.
        • et al.
        Association of the modified frailty index with 30-day surgical readmission.
        JAMA Surg. 2017; 152: 749-757
        • Berian J.R.
        • Mohanty S.
        • Ko C.Y.
        • Rosenthal R.A.
        • Robinson T.N.
        Association of loss of independence with readmission and death after discharge in older patients after surgical procedures.
        JAMA Surg. 2016; 151e161689

      Linked Article

      • Comment on: Preoperative functional health status as a predictor of short-term postoperative morbidity and mortality following bariatric surgery
        Surgery for Obesity and Related DiseasesVol. 15Issue 5
        • Preview
          Kathleen L et al. published a comprehensive study regarding functional health status as a better predictor of postoperative morbidity and mortality of bariatric surgery than age alone. Age is a suboptimal predictor for bariatric surgery outcomes, making it important to look for another predictor to carefully select the most optimal candidates for the surgery [1]. Impaired functional status is associated with increased postoperative morbidities including venous thromboembolism and gastrointestinal leak [2–4], urging the development of customized advice for people with functional status impairment as they need to be warned about potential adverse outcomes and additional risks.
        • Full-Text
        • PDF