Background

Baseline functional status has been recognized as an important predictor of post-operative outcomes. There is no consensus to predict whether it is safe for dependent patients to undergo weight-loss surgery. The purpose of this study is to evaluate the association of functional status with risk of adverse post-operative outcomes.

Methods

The MBSAQIP database was used to identify adult patients undergoing primary Roux-en-Y Gastric Bypass and Sleeve gastrectomy between 2015-2019. Patients undergoing open(n=2438) and those with missing functional status(n=297) were excluded. Independent functional status group was compared to a joint group of partially and totally dependent (requires partial or total assistance for activities of daily living). Post-operative outcomes (emergency department(ED) visit, ICU admissions, 30-days readmissions, reoperations, and interventions) were compared between groups using multivariable binary logistic regression. Odds ratio and 95%-confidence interval(CI) are provided as measures of strength of association and precision, respectively.

Results

A total of 831,004 patients were included in the analysis,823,207(99.06%) were functionally independent and 7,797(0.94%) were dependent. The dependent group were older (51.69 vs 44.38, p<0.0001), more likely male (24.6% vs 19.83%, p<0.0001), and to have obesity-related co-morbidities. After adjusting for demographics, co-morbidities and peri-operative complications, dependent status was associated with increased odds of worse post-surgery outcomes (Table 1), most notably ICU admission (OR=2.6; 95% CI: 2.27, 3.01).

Conclusions

Although dependent patients comprised only 1% of the surgery population, these patients are at increased risk of adverse post-surgery outcomes. Improvement of functional status prior to surgery via prehabilitation should be systematically studied to improve outcomes.