Image: A high waist-to-hip ratio increases odds of complications and death in emergency surgery (Photo courtesy of Shutterstock).
A new study shows that a high waist-to-hip ratio increases odds of complications and death dramatically in patients undergoing emergency operations.
Researchers at the University of Arizona (Tucson, USA) conducted a retrospective study of 608 men and women who underwent emergency general surgery procedures between 2012 and 2016. All patients had CT imaging of the abdomen and pelvis before their operations, which were used to calculate waist-to-hip ratios. The patients were divided into two groups, based on a waist-to-hip ratio cutoff point of one. Main outcome measures included complications, length of hospital stay, mortality, and 30-day readmission.
The results revealed that overall complications rate was 33%, median length of hospital stay was four days, mortality rate was 3.6%, and 30-day readmission rate was 24.8%. But further analysis revealed that the 70% of patients that had a waist-to-hip ratio (as measured on CT) equal to or exceeding one had a dramatically higher complications rate (44.3% versus 8.7%), hospital stay (5.7 days versus 2.8 days), mortality rate (7.7% vs 1.1%), and 30-day readmission rate (32.5% versus 7.1%) when compared to those with a waist-to-hip ratio of less than one.
A waist-to-hip ratio greater or equal to one is thus an independent predictor of complications and death, increasing the odds by seven and six times, respectively. The researchers recommend that waist-to-hip ratio should be considered part of radiology reports in emergency general surgery patients who undergo CT imaging. In addition, they suggest that waist-to-hip ratio can also be easily measured at bedside with a measuring tape if patient CT scan is not available. The study was presented at the American College of Surgeons (ACS) clinical congress, held during October 2017 in San Diego (CA, USA).
“BMI has traditionally been used in hospitals to predict adverse outcomes such as heart attacks, but one of the problems with BMI is that it doesn't take into account body fat distribution. The waist-to-hip ratio, however, specifically targets the concentration of visceral fat, which is the dangerous type surrounding abdominal organs,” said lead author and study presenter Faisal Jehan, MD. “Based on the waist-to-hip ratio, we can predict whether these patients are high risk and then take precautions to keep these patients on the radar.”
“For example, we can call them in for postoperative examinations to check on them early and quickly, and if they do develop complications, we can quickly move them into the ICU so that we can take care of those complications,” concluded Dr. Jehan. “In the emergency room, we don't have a lot of time, but we know that most emergency general surgery patients get a CT scan; the CT scan is a convenient and accessible way to get the waist-to-hip ratio.”
To measure waist circumference accurately, the World Health Organization (WHO) recommends it should be measured mid-way between the lower rib and the iliac crest (the top of the pelvic bone at the hip). Hip measurement is at the widest point.
University of Arizona