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 is traditionally calculated by body mass index (BMI), an indirect measure that does not account for fat distribution. We hypothesized that a direct measure of obesity, waist circumference, 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 CT. Multivariate logistic regression was used to calculate independent predictors of complications. RESULTS From 2002-2009, 152 patients with mean age 65.2±0.75 years and BMI 28.0±0.43kg/m2 underwent elective resection of rectal adenoma or carcinoma. Increasing BMI was not significantly associated with risk of postoperative complications including infection, dehiscence, and reoperation (Table 1). Greater waist circumference independently predicted increased risk of superficial infections (OR 1.98, 95% CI 1.19-3.30, p<0.008). Risk of wound disruption, dehiscence and reoperation were increased with expanding waist circumference but the association did not achieve statistical significance. Overall, increased waist circumference predicted a significantly greater risk of having one or more postoperative complication (OR 1.56, 95% CI 1.04-2.34, p<0.034). CONCLUSIONS Although BMI is easily calculated, it is an indirect measure of obesity that fails to account for differences in fat quantity and distribution. Waist circumference, a direct measure of central adiposity, is a better predictor of short-term complications and can be used to identify patients who may benefit from more aggressive infection control and prevention.
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