Preoperative Body Composition Parameters Are Associated With Postoperative Outcomes in Patients With Crohn’s Disease
Clinical Gastroenterology and Hepatology, vol. 24, pp. 1413–1423
Abstract
BACKGROUND & AIMS: Preoperative body composition is a potential modifiable risk factor for poor postoperative outcomes in Crohn's disease (CD). This study aimed to investigate the association of preoperative body composition parameters with postoperative complications and endoscopic postoperative recurrence (ePOR) in patients with CD following ileocolic (re-)resection (ICR). METHODS: Patients with CD (≥16 years) scheduled for ICR with preoperative abdominal imaging (<12 months) (n = 227) were identified from a prospective, multicenter cohort study. Cross-sectional surface area normalized for body height (ie, index) and lipid content in sketelal muscle mass (SM) and subcutaneous and visceral adipose tissue (SAT/VAT) were analyzed on imaging. Associations with postoperative complications (Clavien-Dindo I-IV), moderate-to-severe complications (Clavien-Dindo ≥II), infectious complications, and ePOR (modified Rutgeerts' score ≥i2b) were explored. RESULTS: High lipid content in SM (ie, myosteatosis) was associated with overall postoperative (adjusted odds ratio [aOR], 3.09; 95% confidence interval [CI], 1.36-7.00), moderate-to-severe (aOR, 2.66; 95% CI, 1.24-5.68), and infectious complications (aOR, 2.44; 95% CI, 1.10-5.40). Low preoperative SAT index was protective against postoperative complications (aOR, 0.38; 95% CI, 0.16-0.88). Low lipid content in VAT was associated with postoperative infectious complications (aOR, 4.31; 95% CI, 1.11-16.71), whereas high lipid content in VAT was protective against ePOR (aOR, 0.26; 95% CI, 0.07-0.99). Both low (aOR, 4.46; 95% CI, 1.09-19.57) and high SM index were associated with ePOR (aOR, 2.45; 95% CI, 1.06-5.65). CONCLUSIONS: Preoperative myosteatosis was consistently associated with overall postoperative complications, moderate-to severe, and infectious complications, in patients with CD following ICR. Furthermore, several body composition parameters were identified as risk factor or protective factor for postoperative complications and ePOR. Inconsistent findings were observed for SM levels and ePOR risk. The correlation between improvements of these parameters and postoperative outcomes requires further study.
Authors 26
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Affiliation as printed
Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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Erasmus MC · IJsselland Ziekenhuis · Erasmus University Rotterdam
Affiliation as printed
Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands; Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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Flevoziekenhuis · Amsterdam University Medical Centers
Affiliation as printed
Department of Surgery, Flevoziekenhuis, Almere, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Affiliation as printed
Department of Gastroenterology and Hepatology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Gastroenterology and Hepatology, Haaglanden Medical Center, The Hague, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers
Affiliation as printed
Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Maastricht University Medical Centre
Affiliation as printed
Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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Affiliation as printed
Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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Affiliation as printed
Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, the Netherlands
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Affiliation as printed
Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
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Affiliation as printed
Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
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University Medical Center Utrecht
Affiliation as printed
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
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Affiliation as printed
Department of Gastroenterology and Hepatology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, AGEM Research Institute, Amsterdam, the Netherlands
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Affiliation as printed
Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
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Affiliation as printed
Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
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Erasmus MC · Erasmus University Rotterdam
Affiliation as printed
Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; Obesity Center CGG, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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Erasmus MC · Erasmus University Rotterdam
Affiliation as printed
Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands. Electronic address: a.c.devries@erasmusmc.nl
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