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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‡‡

doi: 10.1097/SLA.0b013e3182a6605a
Original Articles From the ESA Proceedings

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.

Prospective multicenter international study comparing correlation of measures of obesity with postoperative mortality/morbidity after colorectal surgery among 1349 patients. Waist/hip ratio is a stronger risk factor than body mass index for intraoperative complications, conversion, medical complications, and reoperations. The authors recommend adding the waist/hip ratio to routine practice for risk estimation before colorectal surgery.

*Colorectal Surgery Unit and Colorectal Tumor Board, Cliniques Universitaires Saint-Luc, Brussels, Belgium

Department of Abdominal Surgery, Gasthuisberg University Hospital, Leuven, Belgium

Department of Coloproctology, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom

§Department of Digestive Surgery, Hôpital St-Joseph, Gilly, Belgium

Plateforme technologique de Support en Méthodologie et Calcul Statistique, Université Catholique de Louvain, Louvain-La-Neuve, Belgium

Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

**Department of Colorectal Surgery, Oxford University Hospitals, Oxford, United Kingdom

††Service of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland

‡‡Department of General and Digestive Surgery, Hôpital St-Antoine, Paris, France.

Reprints: Alex H. Kartheuser, MD, PhD, MSc, Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, B-1200 Brussels, Belgium; E-mail:

Waist Circumference Study Group: N. Abbes Orabi (Centre Hospitalier Régional de Mons, Mons, Belgium), S. Achkasov (State Research Centre of Coloproctology, Moscow, Russia), D. Aleshin (State Research Centre of Coloproctology, Moscow, Russia), P. Ambrosetti (Clinique Générale Beaulieu, Geneva, Switzerland), J. Baulieux (CHU de Lyon, Hôpital de la Croix-Rousse, Lyon, France), D. Brandt (Hôpital Saint-Joseph, Gilly, Belgium), F. Bretagnol (Hôpital Beaujon, Clichy, France), P-Y. Bouteloup (Centre Hospitalier Privé de Saint-Grégoire, Saint-Grégoire, France), R. Chamlou (Clinique Saint-Jean, Bruxelles, Belgium), C. Coimbra (CHU du Sart-Tilman, Liège, Belgium), E. Cotte (CHU de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France), G. Decker (Zithaklinik, Luxemburg, Grand Duchy of Luxemburg), A. D'Hoore (KUL UZ Gasthuisberg, Leuven, Belgium), R. Droissart (Clinique Saint-Jean, Bruxelles, Belgium), E. J. Dozois (Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA), J. Etienne (Clinique Sainte-Elisabeth, Namur, Belgium), J-C. Etienne (Centre Hospitalier Inter-communal de Poissy, Poissy, France), J-L. Faucheron (CHU de Grenoble–Hôpital A. Michallon, La Tronche, France), P. Frileux (Hôpital Foch, Suresnes, France), O. Glehen (CHU de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France), C. Jehaes (Les Cliniques Saint-Joseph, Liège, Belgium), A.H. Kartheuser (Cliniques Universitaires Saint-Luc, Bruxelles, Belgium), Kayser J. (Zithaklinik, Luxemburg, Grand Duchy of Luxemburg), Konrad B. (Geneva University Hospitals, Geneva, Switzerland), Z. Krivokapic (Institute for Digestive Disease, Belgrade, Serbia), Ch. Laurent (Hôpital Saint-André, Bordeaux, France), P-A. Lehur (Hôtel Dieu CHU de Nantes, Nantes, France), D. Leonard (Cliniques Universitaires Saint-Luc, Bruxelles, Belgium), J. Loriau (Groupe Hospitalier Saint-Joseph, Paris, France), J-Y. Mabrut (CHU de Lyon, Hôpital de la Croix-Rousse, Lyon, France), B. Majerus (Clinique Saint-Pierre, Ottignies, Belgium), P. Matthiessen (Department of Surgery, Örebro University Hospital, Örebro, Sweden), Meurette G. (Hôtel Dieu CHU de Nantes, Nantes, France), Michot F. (CHU Charles-Nicolle, Rouen, France), B. Monami (Les Cliniques Saint-Joseph, Liège, Belgium), N. Mortensen (John Radcliffe Hospital, Oxford, United Kingdom), B. Navez (Hôpital Saint-Joseph, Gilly, Belgium), Y. Panis (Hôpital Beaujon, Clichy, France), H. Paterson (Western General Hospital, Edinburgh, United Kingdom), F. Penninckx (KUL UZ Gasthuisberg, Leuven, Belgium), J. Pfeifer (University Clinic of Surgery, Graz, Austria), F. Pierard (Clinique Saint-Luc, Bouge, Belgium), M. Pocard (Hôpital Lariboisière, Paris, France), C. Remue (Cliniques Universitaires Saint-Luc, Bruxelles, Belgium), F. Ris (Geneva University Hospitals), Geneva, Switzerland), Ph. Rouanet (CRLC Val d'Aurelle-Paul Lamarque, Montpellier, France), F. Rulli (University Hospital Roma, Roma, Italy), E. Rullier (Hôpital Saint-André, Bordeaux, France), J-P. Saey (Centre Hospitalier Régional de Mons, Mons, Belgium), Y.A. Shelygin (State Research Centre of Coloproctology, Moscow, Russia), C. Soravia (Clinique Générale Beaulieu Geneva, Switzerland), L. Stainier (Clinique Saint-Pierre, Ottignies, Belgium), N. Tinton (Hôpital Saint-Joseph, Gilly, Belgium), E. Tiret (Hôpital Saint-Antoine, Paris, France), Y. Parc (Hôpital Saint-Antoine, Paris, France), J-J. Tuech (CHU Charles-Nicolle, Rouen, France), A. Valverde (Centre Hospitalier Victor Dupouy d'Argenteuil, Argenteuil, France), J. Van de Stadt (Hôpital Erasme, Bruxelles, Belgium), B. Vinson-Bonnet (Centre Hospitalier Intercommunal de Poissy, Poissy, France), Y. Van Molhem (Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium), and T. Yeung (John Radcliffe Hospital, Oxford, United Kingdom).

Supported by grants from Fondation Saint-Luc, Clinique des Pathologies Tumorales du Côlon et du Rectum, and Centre du Cancer, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

Disclosure: The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.