Development and Internal Validation of a Metabolic and Bariatric Surgery Frailty Index (MBS-FI).

Authors

Kaique Filardi, Carolina Michelle Mejia-Alaniz, Sara Saeidishahri, Yin Wu, Dale Bond, Edward Hannoush, Darren Tishler, Pavlos Papasavas

Published in

Obesity surgery. Oct 28, 2026. Epub Oct 28, 2026.

Abstract

Frailty is associated with adverse outcomes after metabolic and bariatric surgery (MBS). Existing bariatric frailty scores include MBSAQIP-derived tools, but reported discrimination is modest and prior accumulating-deficit indices used earlier or restricted cohorts. We developed and internally validated a contemporary adult MBSAQIP deficit index and compared it with the modified Frailty Index-5 (mFI-5) and Bariatric Frailty Score (BFS).
We conducted a retrospective analysis using the MBSAQIP 2023-2024 cohort, including adults undergoing sleeve gastrectomy or Roux-en-Y gastric bypass as a primary or conversion MBS. Preoperative health-deficit variables were coded and summed to create the MBS-FI. Candidate deficits were excluded if missing > 10%, too rare (< 1%), too common (> 80%), or unrelated to age. The data were randomly split into FI-derivation and validation cohorts (70%/30%, respectively). Outcomes included in-hospital mortality, 30-day mortality, serious complications, cardiovascular complications, reoperation, and length of stay > 2 days.
The study identified 359,767 patients, of whom 252,043 were in the derivation cohort. Of 28 candidate variables, 18 remained in the final model. The MBS-FI displayed a right-skewed distribution and a positive correlation with age. Higher MBS-FI scores were progressively associated with adverse outcomes. Although the MBS-FI demonstrated numerically higher discrimination for 30-day and in-hospital mortality, these differences were not statistically significant in the overall cohort (p = 0.33 and p = 0.49, respectively. In the validation cohort, the adjusted model yielded an AUC of 0.74 (95% CI, 0.68-0.79) for 30-day mortality based on 75 events and 0.80 (95% CI, 0.69-0.91) for in-hospital mortality based on 14 events.
The MBS-FI was internally validated and provided incremental discrimination for several non-mortality outcomes. Improvements for mortality were limited, and external validation and assessment of clinical utility are required before routine use.

PMID:
42955611
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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