P0402 Preoperative body composition parameters are associated with postoperative complications and endoscopic postoperative recurrence in patients with Crohn’s disease
Journal of Crohn s and Colitis, vol. 19, pp. i899–i901
Abstract
Abstract Background Alterations in body composition are common among patients with Crohn’s disease (CD) and may represent a modifiable risk factor for dismal postoperative outcomes. This study aimed to investigate the association of preoperative body composition with postoperative complications and endoscopic postoperative recurrence (ePOR) in CD patients following ileocolic (re-)resection (ICR). Methods CD patients (≥16 years) scheduled for ICR with a preoperative CT or MRI scan (<12 months prior to ICR) were identified from an ongoing prospective, multicenter cohort study. Cross-sectional area normalized for body height (i.e. index) and lipid content (i.e. radiation attenuation on CT or signal intensity on MRI) of sketelal muscle (SM), subcutaneous adipose (SAT), and visceral adipose tissue (VAT) were analyzed at L3 level. Cut-offs were based on sex-specific tertiles. The primary outcome was postoperative complications (Clavien-Dindo grade I-IV) within 30 days. Secondary outcomes were moderate-to-severe complications (Clavien-Dindo grade ≥II), infectious complications (intra- or extra-abdominal), and ePOR (modified Rutgeerts’ score ≥i2b) at six months postoperatively. Multivariable logistic regression was performed to assess the association of preoperative body composition with study outcomes. Results In total, 227 patients were included. Preoperative characteristiscs and postoperative outcomes are shown in Table 1. Median interval from preoperative imaging to ICR was 2.3 months (IQR 1.1–4.6). High lipid content of SM (i.e. myosteatosis) was associated with postoperative complications (aOR 2.51; 95%CI 1.21–5.22), moderate-to-severe complications (aOR 2.34; 95%CI 1.13–4.85), and infectious complications (aOR 2.20; 95%CI 1.01–4.80) (Figure 1). Low VAT-index was protective against postoperative complications (aOR 0.17; 95%CI 0.05–0.58). Low lipid content of VAT (aOR 3.98; 95%CI 1.15–13.78) and a high SAT-index (aOR 3.38; 95%CI 1.12–10.15) were associated with infectious complications. High SM-index was associated with ePOR (aOR 2.51; 95%CI 1.09–5.77). Preoperative body mass index (BMI) showed no association with study outcomes in uni- and multivariable analyses. Conclusion Preoperative myosteatosis on abdominal imaging is consistently associated with postoperative complications in patients with CD following ICR. Low VAT-index was identified as protective factor for postoperative complications, while low lipid content of VAT and a high SAT-index were associated with infectious complications. Surprisingly, high SM increased the risk of ePOR. Future research should identify strategies for preoperative improvement of body composition, rather than relying solely on BMI, and investigate if these improvements correlate with better postoperative outcomes.
Authors 21
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Maastricht University Medical Center+, Department Gastroenterology and Hepatology , Maastricht, The Netherlands
Maastricht University Medical Center+, Department of Surgery , Maastricht, The Netherlands
Maastricht University, School for Nutrition and Translational Research in Metabolism NUTRIM , Maastricht, The Netherlands
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Erasmus MC · IJsselland Ziekenhuis
Affiliation as printed
Erasmus University Medical Center Rotterdam, Department of Surgery , Rotterdam, The Netherlands
IJsselland Hospital, Department of Surgery, Capelle aan den IJssel , The Netherlands
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Affiliation as printed
Flevoziekenhuis, Department of Surgery , Almere, The Netherlands
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Affiliation as printed
Zuyderland Medical Center, Department of Gastroenterology and Hepatology, Sittard-Geleen , The Netherlands
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University Medical Center Groningen
Affiliation as printed
University Medical Center Groningen, Department of Gastroenterology and Hepatology , Groningen, The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Radboud University Medical Center, Department of Gastroenterology and Hepatology , Nijmegen, The Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Haaglanden Medical Center, Department of Gastroenterology and Hepatology , the Hague, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center, Department of Gastroenterology and Hepatology , Leiden, The Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Amsterdam University Medical Center, Department of Surgery , Amsterdam, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Maastricht University Medical Center+, Department of Radiology and Nuclear Medicine , Maastricht, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Maastricht University Medical Center+, Department of Surgery , Maastricht, The Netherlands
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Maastricht University · Care and Public Health Research Institute
Affiliation as printed
Maastricht University, Department of Epidemiology- Care and Public Health Research Institute CAPHRI , Maastricht, The Netherlands
Maastricht University, School of Nutrition and Translational Research in Metabolism NUTRIM- Department of Nutrition and Movement Sciences , Maastricht, The Netherlands
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Affiliation as printed
Erasmus University Medical Center Rotterdam, Department of Radiology , Rotterdam, The Netherlands
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Affiliation as printed
Meander Medical Center, Department of Gastroenterology and Hepatology , Amersfoort, The Netherlands
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Affiliation as printed
Rijnstate Hospital, Department of Gastroenterology and Hepatology , Arnhem, The Netherlands
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University Medical Center Utrecht
Affiliation as printed
University Medical Center Utrecht, Department of Gastroenterology and Hepatology , Utrecht, The Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Amsterdam University Medical Center, Department of Gastroenterology and Hepatology , Amsterdam, The Netherlands
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Affiliation as printed
Erasmus University Medical Center Rotterdam, Department of Epidemiology , Rotterdam, The Netherlands
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Affiliation as printed
Erasmus University Medical Center Rotterdam, Department of Gastroenterology and Hepatology , Rotterdam, The Netherlands
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Erasmus MC · Erasmus University Rotterdam
Affiliation as printed
Erasmus University Medical Center Rotterdam, Department of Internal Medicine- Division of Endocrinology , Rotterdam, The Netherlands
Erasmus University Medical Center Rotterdam, Obesity Center CGG , Rotterdam, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Maastricht University Medical Center+, Department of Surgery , Maastricht, The Netherlands
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