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. 2019 Apr 11;8(4):494.
doi: 10.3390/jcm8040494.

A High Visceral-To-Subcutaneous Fat Ratio is an Independent Predictor of Surgical Site Infection after Gastrectomy

Jung Ho Kim  1 , Jinnam Kim  2 , Woon Ji Lee  3 , Hye Seong  4 , Heun Choi  5 , Jin Young Ahn  6 , Su Jin Jeong  7 , Nam Su Ku  8 , Taeil Son  9 , Hyoung-Il Kim  10 , Sang Hoon Han  11 , Jun Yong Choi  12 , Joon-Sup Yeom  13 , Woo Jin Hyung  14 , Young Goo Song  15 , Sung Hoon Noh  16
Affiliations

A High Visceral-To-Subcutaneous Fat Ratio is an Independent Predictor of Surgical Site Infection after Gastrectomy

Jung Ho Kim et al. J Clin Med. .

Abstract

Recent studies have shown that body composition is an important factor that affects surgical site infection (SSI). However, each study has utilized different body composition criteria. Therefore, in this study, we aim to determine the most predictable body composition criteria for the prediction of SSI after gastrectomy. The visceral fat area (VFA), subcutaneous fat area (SFA), and muscle area were assessed by a preoperative-stage computed tomographic (CT) scan. To compare the predictive performance of body composition for SSI, logistic regression models were used, and the models were compared using the receiver operation characteristic (ROC) curve and the area under the curve (AUC) value. Of the 1038 eligible patients, 58 patients (5.6%) developed SSI. The VFA-to-SFA ratio showed the best predictive performance (mean AUC 75.11). The cutoff value for the SSI of the VFA-to-SFA ratio was 0.94, and the sensitivity and specificity were 67.86% and 77.65%, respectively. A multivariate logistic analysis indicated that a total gastrectomy (OR, 2.13; p = 0.017), stage III or IV cancer (OR, 2.66; p = 0.003), and a high VFA-to-SFA ratio (OR, 8.09; p < 0.001) were independent risk factors for SSI after gastrectomy. The VFA-to-SFA ratio is the most predictable body composition model for use in predicting the incidence of SSI after gastrectomy.

Keywords: body composition; gastrectomy; gastric cancer; outcomes; risk factors; surgical site infection; visceral-to-subcutaneous fat ratio.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study process.
Figure 2
Figure 2
Example of body composition measurement at the level of the third lumbar vertebra on a computed tomography scan in the Hounsfield unit by AquariusNET Server.
Figure 3
Figure 3
Receiver operating characteristic curve to compare performance of models to predict surgical site infection after gastrectomy by using 1000 bootstrap samples (a: all surgical site infections; M1-6-1: visceral fat area to subcutaneous fat area as a continuous variable; M1-6-2: visceral fat area to subcutaneous fat area as a binary variable with cut-off point 0.94) (b: organ/space surgical site infection; M2-6-1: visceral fat area to subcutaneous fat area as a continuous variable; M2-6-2: visceral fat area to subcutaneous fat area as a binary variable with a cut-off point of 0.94).
See this image and copyright information in PMC

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