title: Body fat composition assessment using analytic morphomics predicts infectious complications after bowel resection in Crohn's disease.
abstract: BACKGROUND
  Decisions between medical and surgical management of Crohn's disease (CD) incorporate risk assessments for potential complications of each therapy. Analytic morphomics is a novel method of image analysis providing quantifiable measurements of body tissue composition, characterizing body fat more comprehensively than body mass index alone. The aim of this study was to determine the risk factors associated with postoperative complications in CD, incorporating fat composition analysis using analytic morphomics.
  
  
  METHODS
  We performed a retrospective review of adults undergoing bowel resection for CD between 2004 and 2011 at a single center. Computed tomography obtained within 30 days prior to surgery underwent morphomic analysis for fat characterization. Postoperative infectious complications were defined as the need for a postoperative abdominal drain, intravenous antibiotics, or reoperation within 30 days. Bivariate and multivariate analyses using logistic regression were used to generate a prediction model of infectious complications.
  
  
  RESULTS
  A total of 269 subjects met selection criteria; 27% incurred postoperative infectious complications. Bivariate analysis showed hemoglobin, albumin, surgical urgency, high-dose prednisone use, and subcutaneous-to-visceral fat volume distribution as predictors of complications. Body mass index, anti-tumor necrosis factor alpha therapies, and immunomodulator use were not predictors of complication. Multivariate modeling demonstrated a c-statistic of 0.77 and a negative predictive value of 81.1% with surgical urgency (odds ratio = 2.78; 95% confidence interval, 1.46-6.02; P = 0.004), subcutaneous-to-visceral fat distribution (odds ratio = 2.01; 95% confidence interval, 1.20-3.19; P = 0.006), and hemoglobin (odds ratio = 0.69; 95% confidence interval, 0.55-0.85; P = 0.001) as predictors of infectious complication.
  
  
  CONCLUSIONS
  Fat subtype and distribution are predictive of postoperative infectious complications after bowel resection for CD. Analytic morphomics provides additional body composition detail not captured by body mass index.
authors.affiliation: *Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan; †VA Ann Arbor Health Services Research and Development Center for Clinical Management Research, Ann Arbor, Michigan; Departments of ‡Internal Medicine and §Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Stidham
authors.forename: Akbar K
authors.initials: AK
authors.lastname: Waljee
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Day
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Bergmans
authors.forename: Katelin M
authors.initials: KM
authors.lastname: Zahn
authors.forename: Peter D R
authors.initials: PD
authors.lastname: Higgins
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Wang
authors.forename: Grace L
authors.initials: GL
authors.lastname: Su
mesh_terms: D050153:Abdominal Fat / Q000000981:diagnostic imaging; D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
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