Abstract
Background
Low muscle mass is increasingly recognised in patients with Crohn’s disease, particularly among those requiring intestinal surgery. While reduced muscle mass has been associated with adverse early surgical outcomes, its relationship with postoperative endoscopic recurrence remains poorly defined.
Objectives
To evaluate the association between preoperative low muscle mass, postoperative complications and endoscopic recurrence after ileocolic resection for Crohn’s disease.
Design
We conducted a retrospective cohort study including consecutive adult patients with Crohn’s disease undergoing ileocolic resection between 2017 and 2024.
Methods
Muscle mass was assessed on preoperative computed tomography or magnetic resonance imaging using the total psoas area index (TPAI) with sex-specific cut-offs. The primary outcome was early postoperative complications (Clavien–Dindo grade ≥II). Secondary outcomes included endoscopic recurrence, defined as Rutgeerts score ≥i2 at follow-up endoscopy (6–12 months after surgery), and clinical factors associated with low muscle mass.
Results
A total of 152 patients were included, of whom 61 (40.1%) were classified as having low muscle mass. Postoperative complications occurred in 25.7% of patients and endoscopic recurrence in 50.7% at 6–12 months. Low muscle mass was independently associated with early postoperative complications (OR 2.80, 95% CI 1.24–6.29) and with endoscopic recurrence (OR 2.20, 95% CI 1.13–4.57). Upper gastrointestinal involvement was independently associated with low muscle mass, whereas prior exposure to biologic therapy showed an inverse association. Body mass index showed only a weak correlation with imaging-based muscle mass.
Conclusion
Preoperative low muscle mass is common in patients with Crohn’s disease undergoing ileocolic resection and was independently associated with both early postoperative complications and endoscopic recurrence. Imaging-based body composition assessment may improve perioperative risk stratification.