title: Association between high visceral fat area and postoperative complications in patients with Crohn's disease following primary surgery.
abstract: OBJECTIVE
  The aim of this study was to determine the association between visceral fat area (VFA) on CT and postoperative complications after primary surgery in patients with Crohn's disease (CD).
  
  
  METHODS
  Inclusion criteria were patients with a confirmed diagnosis of CD who had preoperative abdominal CT scan. The areas of total fat, subcutaneous fat and visceral fat were measured using an established image-analysis method at the lumbar 3 (L3) level on CT cross-sectional images. Visceral obesity was defined as a visceral fat area (VFA) of ≥ 130 cm(2) . Clinical variables, intra-operative outcomes and postoperative courses within 30 days were analysed.
  
  
  RESULTS
  A total of 164 patients met the inclusion criteria. Sixty-three (38.4%) patients had postoperative complications. The mean age of the patients with complications (the study group) was 40.4 ± 15.4 years and of those without complications (the control group) was 35.8 ± 12.9 years (P = 0.049). There were no differences in disease location and behaviour between patients with or without complications (P > 0.05). In 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) were found to be associated with postoperative complications. Patients with visceral obesity had a significantly longer operative time (P = 0.012), more blood loss (P = 0.019), longer bowel resection length (P = 0.003), postoperative ileus (P = 0.039) and a greater number of complications overall (P < 0.001).
  
  
  CONCLUSIONS
  High VFA was found to be associated with an increased risk for 30-day postoperative complications in patients with CD undergoing primary surgery.
authors.affiliation: Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Ding
authors.affiliation: Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: X-R
authors.initials: XR
authors.lastname: Wu
authors.affiliation: Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Remer
authors.affiliation: Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: L
authors.initials: L
authors.lastname: Lian
authors.affiliation: Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: L
authors.initials: L
authors.lastname: Stocchi
authors.affiliation: Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: A
authors.initials: A
authors.lastname: McCullough
authors.affiliation: Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: F H
authors.initials: FH
authors.lastname: Remzi
authors.affiliation: Departments of Colorectal Surgery, Abdominal Imaging, and Gastroenterology/Hepatology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: B
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D003113:Colonoscopy; D003424:Crohn Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology; D007410:Intestinal Diseases / Q000209:etiology; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications* / Q000000981:diagnostic imaging; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011184:Postoperative Period; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Body mass index; Crohn's disease; postoperative complications; primary surgery; visceral fat area; visceral obesity