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High Visceral Fat Area Is Association With Postoperative Complications in Patients With Crohn's Disease Following Primary Surgery
Zhao Ding^*1, Lei Lian², Luca Stocchi¹, Erick M. Remer³, Arthur J. Mccullough², Feza H. Remzi¹, Bo Shen^2
1Colorectal Surgery, Digestive Disease Institution, Cleveland, OH; ²Gastroenterology/Hepatology, Cleveland, OH; ³Abdominal Imaging, Cleveland, OH

BACKGROUND: A majority of patients with Crohn's disease (CD) eventually require surgery. It is important to recognize predictors of perioperative outcomes in these patients. The aim of the study was to determine whether visceral fat area (VFA) based on measurements from computed tomography (CT) is associated with postoperative complications after the primary surgery in patients with CD.
METHODS: A total of 164 patients with confirmed diagnosis of CD who had preoperative abdominal CT scans met the inclusion criteria. The areas of total fat, subcutaneous fat and visceral fat were measured using established image analysis method at lumbar 3 (L3) level on CT cross-sectional image. Visceral obesity was defined by visceral fat area (VFA) ≥ 1.3 dm2. Clinical variables, intraoperative outcomes and postoperative courses within 30 days were analyzed.
RESULTS: Sixty-three patients (38.4%) had postoperative complications. The mean age of the patients with complications (the study group) was 40.4 (40.4±15.4) years, and in patients without complications (the control group) was 35.8 (35.8±12.9) years (P=0.049). Patients with corticosteroid use (within three months preoperatively) more likely developed complications than those without use (66.1% vs. 43.6%, P = 0.005). There were no differences in disease location and behavior classified by the Montreal Classification between patients with or without complications (P>0.05). On multivariable analysis, VFA (odds ratio [OR]=2.69; 95% confidence interval [CI]: 1.09-6.62; P=0.032) and corticosteroid use (OR=2.86; 95% CI: 1.32-6.21; P=0.008) remained independently association with postoperative complications. Patients classified as visceral obesity had a significantly longer operative time (P=0.012), more blood loss (P=0.019), and longer bowel resection length (P=0.003). The 30-day postoperative ileus (P=0.039) and overall complications (P<0.001) were more common in patients with visceral obesity.
CONCLUSION: High VFA as measured by CT scan is associated with an increased risk for 30-days postoperative complications in patient with CD undergoing primary surgery.

Multivariate Analysis for Predictor of Adverse Outcomes of Patients after Primary Surgery

Variables	Odds ratio(95% CI)	P Value
Age	0.98(0.94-1.01)	0.220
Smoking	0.44(0.19-1.00)	0.051
Steroids Use	2.86(1.32-6.21)	0.008
Body mass index	0.98(0.89-1.08)	0.646
Mesenteric fat index	1.26(0.54-2.95)	0.587
Visceral fat area	2.69(1.09-6.62)	0.032
Operative time	1.00(0.99-1.01)	0.966
Estimated blood loss	1.00(1.00-1.01)	0.080
Total bowel resection	1.00(0.99-1.02)	0.807

Intraoperative and Short-term Postoperative Outcomes Comparison between the non-Visceral Obesity and Visceral Obesity Patients

Outcomes		Non-Visceral Obesity VFA<1.30 dm2	Visceral Obesity VFA ≥1.30 dm2	P value
Number of patients		114	50
Operative time(min) a		155.7±55.0	183.4±77.3	0.012
Length of Incision(cm) a		5.4±1.8	5.8±3.4	0.520
Estimated blood loss(ml) a		153.1±152.2	277.0±339.5	0.019
Length of bowel resection(cm) a		39.6±23.3	52.0±26.9	0.003
	Small bowel a	22.2±19.3	29.4±23.0	0.038
	Large bowel a	17.4±21.7	22.5±28.5	0.263
Length of hospital stay(day) a		8.8±5.2	9.1±4.9	0.763
ICU stay(day) a		0.2±1.1	0.5±1.9	0.265
Readmission within 30 days b		18(15.8)	6(12.0)	0.527
Reoperation within 30 days b		6(5.3)	3(6.0)	1.000
Overall complications b		33(28.9)	31(60.0)	0.000

a Data expressed as Mean ± Standard Deviation; b Data expressed as N(%)

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