title: Waist circumference predicts increased complications in rectal cancer surgery.
abstract: BACKGROUND
  The impact of obesity on development of postoperative complications after gastrointestinal surgery remains controversial. This may be due to the fact that obesity has been calculated by body mass index, a measure that does not account for fat distribution. We hypothesized that waist circumference, a measure of central obesity, would better predict complications after high-risk gastrointestinal procedures.
  
  
  METHODS
  Retrospective review of an institutional cancer database identified consecutive cases of men undergoing elective rectal resections. Waist circumference was calculated from preoperative imaging.
  
  
  RESULTS
  From 2002 to 2009, 152 patients with mean age 65.2 ± 0.75 years and body mass index 28.0 ± 0.43 kg/m(2) underwent elective resection of rectal adenoma or carcinoma. Increasing body mass index was not significantly associated with risk of postoperative complications including infection, dehiscence, and reoperation. Greater waist circumference independently predicted increased risk of superficial infections (OR 1.98, 95% CI 1.19-3.30, p < 0.008) and a significantly greater risk of having one or more postoperative complications (OR 1.56, 95% CI 1.04-2.34, p < 0.034).
  
  
  CONCLUSIONS
  Waist circumference, a measure of central obesity, is a better predictor of short-term complications than body mass index and can be used to identify patients who may benefit from more aggressive infection control and prevention.
authors.affiliation: Michael E DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. cb131098@bcm.tmc.edu
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Balentine
authors.forename: Celia N
authors.initials: CN
authors.lastname: Robinson
authors.forename: Christy R
authors.initials: CR
authors.lastname: Marshall
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wilks
authors.forename: William
authors.initials: W
authors.lastname: Buitrago
authors.forename: Kujtim
authors.initials: K
authors.lastname: Haderxhanaj
authors.forename: Shubhada
authors.initials: S
authors.lastname: Sansgiry
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Petersen
authors.forename: Vivek
authors.initials: V
authors.lastname: Bansal
authors.forename: Daniel
authors.initials: D
authors.lastname: Albo
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009765:Obesity / Q000150:complications / Q000175:diagnosis; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000175:diagnosis; D013530:Surgical Wound Infection / Q000175:diagnosis; D055105:Waist Circumference