Preoperative Body Composition Parameters Are Associated With Postoperative Outcomes in Patients With Crohn's Disease

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).

Conclusion: 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.

Keywords: Body Composition; Crohn’s Disease; Myosteatosis; Postoperative Complications; Postoperative Recurrence; Prehablitation.