When body mass index fails to measure up: perinephric and periumbilical fat as predictors of operative risk.
BACKGROUND
Obesity has been associated with worse outcomes and increased surgical technical difficulty. Perinephric fat (PNF) and periumbilical fat (PUF) are alternative metrics to body mass index. We hypothesized that PUF and PNF would offer improved prediction of perioperative risk.


METHODS
249 patients were retrospectively reviewed after elective, pelvic colorectal resections. PNF and PUF were collected using axial imaging. Operative risk measurements included estimated blood loss (EBL) and operative time (OT).


RESULTS
In multivariate analyses of women, PUF and PNF were significant predictors of EBL; PNF was a significant predictor of OT. A 4.7-mm increase in PNF predicted a 15-minute increase in OT and 55-cc increase in EBL. An 8.6-mm increase in PUF predicted a 55-cc increase in EBL. In men, no metric was predictive.


CONCLUSIONS
In women, PNF and PUF may offer improved metrics for risk stratification, which can have important clinical and financial implications.
Department of Surgery, University of Utah, Salt Lake City, UT, USA.
Luke
L
Martin
Department of Surgery, University of Utah, Salt Lake City, UT, USA.
Gillian
G
Seton
Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
Booth
B
Aldred
Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA.
Paul
P
Hopkins
Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
Jessica
J
Chan
Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
Marta E
ME
Heilbrun
Department of Surgery, University of Utah, Salt Lake City, UT, USA.
Mary
M
Mone
Department of Surgery, University of Utah, Salt Lake City, UT, USA.
Courtney
C
Scaife
Department of Surgery, University of Utah, Salt Lake City, UT, USA. Electronic address: William.Peche@hsc.utah.edu.
William
W
Peche
D000005:Abdomen / Q000601:surgery*; D050154:Adiposity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000601:surgery; D061646:Operative Time; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D055815:Young Adult
Body mass index; Colorectal surgery; Obesity; Perinephric fat; Perioperative risk assessment; Periumbilical fat