Skip Navigation LinksHome > November 2013 - Volume 258 - Issue 5 > Waist Circumference and Waist/Hip Ratio Are Better Predictiv...
Annals of Surgery:
doi: 10.1097/SLA.0b013e3182a6605a
Original Articles From the ESA Proceedings

Waist Circumference and Waist/Hip Ratio Are Better Predictive Risk Factors for Mortality and Morbidity after Colorectal Surgery Than Body Mass Index and Body Surface Area

Kartheuser, Alex H. MD, PhD, MSc*; Leonard, Daniel F. MD*; Penninckx, Freddy MD, PhD; Paterson, Hugh M. MD, FRCSEd*,‡; Brandt, Dimitri MD*,§; Remue, Christophe MD*; Bugli, Céline PhD; Dozois, Eric MD; Mortensen, Neil MD, PhD**; Ris, Frédéric MD††; Tiret, Emmanuel MD, PhD‡‡

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Abstract

Objectives: To determine whether body fat distribution, measured by waist circumference (WC) and waist/hip ratio (WHR), is a better predictor of mortality and morbidity after colorectal surgery than body mass index (BMI) or body surface area (BSA).

Background: Obesity measured by BMI is not a consistent risk factor for postoperative mortality and morbidity after abdominal surgery. Studies in metabolic and cardiovascular diseases have shown WC and WHR to be better outcome predictors than BMI.

Methods: A prospective multicenter international study was conducted among patients undergoing elective colorectal surgery. The WHR, BMI, and BSA were derived from body weight, height, and waist and hip circumferences measured preoperatively. Uni- and multivariate analyses were performed to identify risk factors for postoperative outcomes.

Results: A total of 1349 patients (754 men) from 38 centers in 11 countries were included. Increasing WHR significantly increased the risk of conversion [odds ratio (OR) = 15.7, relative risk (RR) = 4.1], intraoperative complications (OR = 11.0, RR = 3.2), postoperative surgical complications (OR = 7.7, RR = 2.0), medical complications (OR = 13.2, RR = 2.5), anastomotic leak (OR = 13.7, RR = 3.3), reoperations (OR = 13.3, RR = 2.9), and death (OR = 653.1, RR = 21.8). Both BMI (OR = 39.5, RR = 1.1) and BSA (OR = 4.9, RR = 3.1) were associated with an increased risk of abdominal wound complication. In multivariate analysis, the WHR predicted intraoperative complications, conversion, medical complications, and reinterventions, whereas BMI was a risk factor only for abdominal wall complications; BSA did not reach significance for any outcome.

Conclusions: The WHR is predictive of adverse events after elective colorectal surgery. It should be used in routine clinical practice and in future risk-estimating systems.

© 2013 by Lippincott Williams & Wilkins.

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