Association of body composition with postoperative complications after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

Objective: To evaluate predictive values of body composition parameters measured from preoperative CT/MRIs for postoperative complications after laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) in patients with obesity. Methods: In this retrospective case-control study, patients performing abdominal CT/MRIs within one month before and developing 30-day complications after bariatric procedures were matched for age, sex, and type of surgery with patients without complications (1/3 ratio, respectively). Complications were determined by documentation in the medical record. Two readers blindly segmented the total abdominal muscle area (TAMA) and visceral fat area (VFA) using predetermined thresholds for the Hounsfield unit (HU) on unenhanced CT and the signal intensity (SI) on T1-weighted MRI at the L3 vertebral level. Visceral obesity (VO) was defined as VFA > 136 cm2 in males and > 95 cm2 in females. These measures, along with perioperative variables, were compared. Multivariate logistic regression analyses were performed. Results: Of 145 included patients, 36 had postoperative complications. No significant differences between LSG and LRYGB were present regarding complications and VO. Hypertension (p = 0.022), impaired lung function (p = 0.018), American Society of Anesthesiologists (ASA) grade (p = 0.046), VO (p = 0.021), and VFA/TAMA ratio (p < 0.0001) were associated with postoperative complications in the univariate logistic analysis; the VFA/ TAMA ratio was the only independent predictor in multivariate analyses (OR 2.01, 95% CI 1.37-2.93, p < 0.001). Conclusion: The VFA/TAMA ratio provides important perioperative information in predicting patients who are likely to develop postoperative complications undergoing bariatric surgery.