Beyond Body Mass Index: CT-Based Sarcopenia and Major Complication Severity After Right Hemicolectomy.

INTRODUCTION Sarcopenia and sarcopenic obesity (SO) are increasingly recognized as CT-based body composition phenotypes associated with adverse surgical outcomes. This study evaluated the relationship of clinical-demographic factors and CT-based body composition parameters with minor versus major postoperative complication severity after elective right hemicolectomy.

Methods

This retrospective study included 51 patients with documented postoperative morbidity after elective right hemicolectomy and ileotransversostomy. Age, sex, American Society of Anesthesiologists class, surgical indication, operative approach, BMI category, psoas muscle index (PMI), visceral fat area (VFA), sarcopenia, visceral obesity, and SO were evaluated. Postoperative complications were graded using the Clavien-Dindo classification and grouped as minor (grades I-II) or major (grades III-V). Receiver operating characteristic analysis assessed the discriminatory ability of BMI, low PMI, and VFA for major complication severity.

Results

Major complications occurred in 12 patients (23.5%). Older age (P = 0.047), American Society of Anesthesiologists class (P = 0.038), BMI category (P = 0.007), sarcopenia (50.0% versus 11.4%; P = 0.005), and SO (50.0% versus 13.5%; P = 0.011) were associated with major complication severity. Visceral obesity alone was not significant (P = 0.232). Low PMI showed the highest discriminatory performance for major complication severity (area under the curve [AUC] = 0.771), whereas BMI showed an inverse pattern (AUC = 0.110), and VFA showed limited discriminatory ability (AUC = 0.370). No evaluated parameter was significantly associated with length of hospital stay.

Conclusions

In patients with documented postoperative morbidity after elective right hemicolectomy, CT-based sarcopenia, SO, and BMI were associated with major rather than minor complication severity. Low PMI showed the strongest discriminatory performance, while BMI demonstrated an inverse pattern consistent with the obesity paradox. CT-based skeletal muscle assessment may add clinically relevant information to conventional preoperative risk stratification.