Cardiovascular Risk, Comorbidity and Frailty in Patients Undergoing Sleeve Gastrectomy: A Population-Based Study.

BACKGROUND: Cardiometabolic conditions and frailty influence perioperative risk in bariatric surgery; however, contemporary population-level studies describing these factors are limited. This study characterised the cardiometabolic burden, comorbidity, and frailty of adults undergoing laparoscopic sleeve gastrectomy (LSG), with comparisons according to sex and hospital setting. METHOD: A population-based cohort study was conducted using statewide administrative hospital data from all public and private hospitals in New South Wales, Australia, between 1 July 2017 and 30 June 2022. Adults (≥18 years) undergoing primary LSG were included. The prevalence of cardiometabolic comorbidities and trends in age-adjusted disease rates were assessed. Subgroup analyses according to sex and hospital setting were performed for cardiovascular risk factors, comorbidity, and frailty. RESULTS: Among 34,738 patients (78.3% female; 96.6% treated in private hospitals; mean age 41.3±11.5 years), nearly three-quarters (72.3%, n=25,130) had one or more cardiovascular risk factors. The prevalence of type 2 diabetes mellitus (T2DM) declined by 24.4% (148.8-112.5 per 1,000; p<0.001). Males had a higher cardiovascular risk burden (44.3% vs 28.0% with ≥2 risk factors; p<0.001), greater comorbidity burden (Elixhauser index: 1.35 vs 1.07; p<0.001), and higher frailty scores (Claims Frailty Index: 0.12 vs 0.11; p<0.001). Public hospital patients, particularly males, had the highest burden across all measures. CONCLUSIONS: There was substantial variation in cardiometabolic burden among LSG recipients according to sex and hospital sector. The observed decline in T2DM suggests a change in the clinical profile of patients undergoing surgery. These findings warrant further investigation into the factors influencing access to surgery and patient selection.