{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T22:52:46Z","timestamp":1781477566858,"version":"3.54.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity is a recognized risk factor for postoperative complications after spine surgery, but body mass index (BMI) does not capture regional fat distribution. The visceral-to-subcutaneous fat area (VFA\/SFA) ratio measured on CT reflects an unfavorable fat distribution pattern, yet its role in wound healing after posterior lumbar fusion (PLF) is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 526 adults who underwent instrumented PLF for degenerative lumbar pathology and had preoperative non-contrast abdominal CT including the L4\u2013L5 level. On a single axial slice at L4\u2013L5, visceral fat area (VFA) and subcutaneous fat area (SFA) were segmented using a semi-automated protocol and the VFA\/SFA ratio was calculated and grouped into quartiles. The primary outcome was impaired wound healing within 30 days, defined as persistent erythema or swelling, fat liquefaction, prolonged serous\/serosanguinous exudation, partial wound edge necrosis or superficial dehiscence, or the need for negative-pressure therapy, delayed suture removal, additional antibiotics, or surgical debridement. Group comparisons used t tests and\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      tests. Univariable and multivariable logistic regression were performed, and discrimination of BMI, VFA, SFA, VFA\/SFA, and clinical prediction models was assessed using receiver operating characteristic curves.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Impaired wound healing occurred in 59 patients (11.2%). Compared with patients with good healing, those with impaired wound healing had higher BMI (25.4\u2009\u00b1\u20094.0 vs. 23.1\u2009\u00b1\u20093.8\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and higher VFA\/SFA ratio (1.063\u2009\u00b1\u20090.246 vs 0.895\u2009\u00b1\u20090.259,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), whereas SFA did not differ. Each 0.1 increase in VFA\/SFA ratio was associated with an adjusted odds ratio of 1.32 (95% CI 1.16\u20131.50;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) for impaired wound healing, independent of age, sex, BMI, diabetes, ASA class, albumin, multilevel fusion, operative time, and blood loss. The AUC was 0.66 for BMI and 0.70 for VFA\/SFA; adding VFA\/SFA to a clinical model increased the AUC from 0.70 to 0.77.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The preoperative VFA\/SFA ratio at L4\u2013L5 is an independent predictor of impaired wound healing after PLF and provides incremental discriminative value beyond BMI and conventional clinical risk factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1757071","type":"journal-article","created":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T22:10:25Z","timestamp":1781475025000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond BMI: L4\u2013L5 visceral-to-subcutaneous fat ratio on CT predicts impaired wound healing after posterior lumbar fusion\u2014A retrospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jinwang","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College","place":["Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoping","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College","place":["Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoxing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Chengdu Medical College","place":["Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College","place":["Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"756","DOI":"10.14444\/8659","article-title":"Comparison of clinical efficacy in the treatment of lumbar degenerative disease: posterior lumbar interbody fusion, posterior lumbar fusion, and hybrid surgery","volume":"18","author":"Zhu","year":"2024","journal-title":"Int J Spine Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"92s","DOI":"10.1177\/2192568219844228","article-title":"Surgical site infection prevention following spine surgery","volume":"10","author":"Aleem","year":"2020","journal-title":"Global Spine J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12891-023-06217-z","article-title":"Overweight increases perioperative spinal surgery complications: a single-center retrospective study","volume":"24","author":"Hirahata","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"B4","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3390\/ijerph14020183","article-title":"Associations between obesity and spinal diseases: a medical expenditure panel study analysis","volume":"14","author":"Sheng","year":"2017","journal-title":"Int J Environ Res Public Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"291","DOI":"10.3171\/spi.2007.6.4.1","article-title":"Obesity and spine surgery: relation to perioperative complications","volume":"6","author":"Patel","year":"2007","journal-title":"J Neurosurg Spine"},{"key":"B6","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12966-025-01719-6","article-title":"Bmi or not to BMI? 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