Preoperative Risk Stratification Using Radiographic Measures of Central Obesity

Area of Science:

• Radiology and Imaging
• Metabolic Health
• Orthopedic Surgery

Background:

• Body Mass Index (BMI) is a standard obesity measure but doesn't reflect fat distribution.
• Central adiposity is linked to surgical complexity and metabolic risk, making BMI insufficient for preoperative assessment.
• Objective body composition metrics are needed for accurate patient risk stratification.

Purpose of the Study:

• To compare the predictive power of CT-derived abdominal circumference (AC) and abdominal-to-pelvic circumference (ACPC) ratio against BMI for cardiometabolic comorbidities.
• To assess the utility of these radiographic measures in orthopedic patients undergoing surgery.

Main Methods:

• Retrospective cohort study of 134 orthopedic surgery patients.
• Analysis of preoperative abdominopelvic CT scans to measure AC, pelvic circumference, and BMI.
• Correlation of body composition measures with cardiometabolic conditions (diabetes, hypertension) and lipid profiles using logistic regression and ROC analysis.

Main Results:

• Abdominal circumference (AC) showed the strongest association with diabetes and hypertension.
• The AC and ACPC ratio demonstrated superior predictive performance compared to BMI, particularly in patients with BMI >30 kg/m².
• ACPC ratio, unlike BMI, was significantly correlated with high-density lipoprotein and triglyceride levels.

Conclusions:

• Radiographic AC and ACPC ratio are effective indicators of central adiposity and cardiometabolic risk.
• These imaging-based metrics may enhance preoperative risk stratification in orthopedic surgery, especially for overweight patients.
• AC and ACPC ratio offer practical, objective tools for optimizing patient care across various surgical and medical fields.