The impact of BMI on frailty screening and the frailty phenotype in ventral hernia patients.

Background: Ventral hernia repair (VHR) is a common procedure, but assessing surgical candidacy remains complex, particularly in the setting of obesity. Frailty is a well-established predictor of poor surgical outcomes and is traditionally associated with underweight phenotypes. However, obesity is increasingly recognized as a risk factor for frailty as well. Given the lack of consensus on the optimal frailty screening tool and the high prevalence of obesity in the VHR population, understanding how frailty presents in VHR patients with high BMI is essential. This study examines how obesity influences the frailty phenotype in VHR patients and evaluates how different screening tools classify frailty in this population.

Methods: Patients evaluated for VHR at an academic medical center between January and June 2023 were prospectively enrolled. Frailty was assessed using the Modified Frailty Index (mFI-11), Fried Frailty Index (FFI), FRAIL Scale, and SARC-F. The association between BMI and each frailty screening tool was assessed.

Results: Sixty-two patients were enrolled (mean age: 60 years, mean BMI: 32.5 kg/m², 58% obese). BMI demonstrated weak positive correlations with FFI (r = 0.284, p = 0.026) and FRAIL Scale (r = 0.332, p = 0.008). In univariate regression, higher BMI was significantly associated with screening positive on FRAIL Scale (OR: 1.10, 95% CI: 1.02-1.21) and SARC-F (OR: 1.09, 95% CI: 1.01-1.19). In multivariate regression, BMI independently predicted FRAIL Scale positivity (aOR: 1.44, 95% CI: 1.06-1.95) but no other frailty screening tools. Higher BMI was also significantly associated with specific frailty components, including fatigue and mobility limitations.

Conclusion: Frailty is highly prevalent in obese VHR patients, and high BMI increases the risk of presenting with functional mobility impairments. Frailty screening tools vary in their ability to capture these functional limitations. Future research is needed to compare the ability of different frailty screening tools to predict postoperative outcomes in larger VHR cohorts.