Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 28 4 2025, Pages S1542-3565(25)00636-6 Preoperative body composition parameters are associated with postoperative outcomes in patients with Crohn's disease. Bak MTJ, Demers K, van Ruler O, Pierik MJ, van Dijk DPJ, van der Bilt JDW, Romberg-Camps M, Dijkstra G, Duijvestein M, van der Marel S, Maljaars PWJ, Buskens CJ, Bakers FCH, Brecheisen R, Bongers BC, de Witte D, Jansen SV, Jharap B, Horjus CS, van Schaik FDM, West RL, de Boer NKH, Hansen BE, van der Woude CJ, van Rossum EFC, Stassen LPS, de Vries AC, RAP-CD study group, Dutch Initiative on Crohn and Colitis (ICC) & Dutch Initiative on Crohn and Colitis – Surgery (ICC-S)
Background and 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 CD patients following ileocolic (re-)resection (ICR).
Methods
CD patients (≥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 (i.e. index) and lipid content in sketelal muscle mass (SM), 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 (i.e. myosteatosis) was associated with overall postoperative (aOR 3.09;95%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), while 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.
