title: Body mass index and the risk of postoperative cerebrospinal fluid leak following transsphenoidal surgery in an Asian population.
abstract: Postoperative cerebrospinal fluid (CSF) leak is a serious complication following transsphenoidal surgery for which elevated body mass index (BMI) has been implicated as a risk factor, albeit only in two recent North American studies. Given the paucity of evidence, we sought to determine if this association holds true in an Asian population, where the BMI criteria for obesity differ from the international standard.
  
  
  
  A retrospective study of 119 patients who underwent 123 transsphenoidal procedures for sellar lesions between May 2000 and May 2012 was conducted. Univariate and multivariate logistic regression analyses were performed to investigate the impact of elevated BMI and other risk factors on postoperative CSF leak.
  
  
  
  10 (8.1%) procedures in ten patients were complicated by postoperative CSF leak. The median BMI of patients with postoperative leak following transsphenoidal procedures was significantly higher than that of patients without postoperative CSF leak (27.0 kg/m2vs. 24.6 kg/m2; p = 0.018). Patients categorised as either moderate or high risk under the Asian BMI classification were more likely to suffer from a postoperative leak (p = 0.030). Repeat procedures were also found to be significantly associated with postoperative CSF leak (p = 0.041).
  
  
  
  Elevated BMI is predictive of postoperative CSF leak following transsphenoidal procedures, even in an Asian population, where the definition of obesity differs from international standards. Thus, BMI should be considered in the clinical decision-making process prior to such procedures.
authors.affiliation: Division of Neurosurgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore.
authors.forename: Ira
authors.initials: I
authors.lastname: Sun
authors.affiliation: Division of Neurosurgery, Department of General Surgery, National University Hospital, Singapore.
authors.forename: Jia Xu
authors.initials: JX
authors.lastname: Lim
authors.affiliation: Division of Neurosurgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore.
authors.forename: Chun Peng
authors.initials: CP
authors.lastname: Goh
authors.affiliation: Division of Neurosurgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore.
authors.forename: Shiong Wen
authors.initials: SW
authors.lastname: Low
authors.affiliation: Division of Neurosurgery, Department of General Surgery, Khoo Teck Puat Hospital, Singapore.
authors.forename: Ramez W
authors.initials: RW
authors.lastname: Kirollos
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Chuen Seng
authors.initials: CS
authors.lastname: Tan
authors.affiliation: Division of Neurosurgery, Department of General Surgery, National University Hospital, Singapore.
authors.forename: Sein
authors.initials: S
authors.lastname: Lwin
authors.affiliation: Division of Neurosurgery, Department of General Surgery, National University Hospital, Singapore.
authors.forename: Tseng Tsai
authors.initials: TT
authors.lastname: Yeo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D044466:Asian People; D015992:Body Mass Index; D001835:Body Weight; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009765:Obesity / Q000145:classification; D011183:Postoperative Complications; D011184:Postoperative Period; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore; D055815:Young Adult
keywords: Asian; body mass index; cerebrospinal fluid leak; transsphenoidal surgery