Visceral obesity determined in routine preoperative CT scans predicts risk of postoperative burst abdomen

Burst abdomen (BA) remains a severe postoperative complication after abdominal surgery. Obesity is a known risk factor for postoperative complications but objective parameters such as body mass index fail to predict BA after abdominal surgery. In recent literature, CT-derived body composition assessment could predict obesity-related diseases and surgical site infections. We report data from the institutional wound register, comparing patients with BA to a subgroup of patients without BA. The CT images were evaluated for intraabdominal and subcutaneous fat tissues. Univariate and multivariate risk factor analysis was performed in order to evaluate CT-derived obesity parameters as risk factor for BA. 92 patients with BA were compared to 32 controls. Patients with BA had significantly more visceral obesity (VO; p < 0.001) but less subcutaneous obesity (SCO) on CT scans. VO and SCO both were positively correlated with BMI (r = 0.452 and 0.572) but VO and SCO were inversely correlated (r = -0.189). Multivariate analysis revealed VO as significant risk factor for postoperative BA (OR 1.257; 95% CI 1.084-1.459; p = 0.003). Our analysis of patients with postoperative BA revealed VO as major risk factor for postoperative BA. Thus, preoperative CT scans gives valuable information on possible risk stratification.