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Introduction
Increased perinephric adipose tissue (PAT) is correlated with increased surgical complexity.  Risk factors for its accumulation are not well understood.  Identifying such risk factors may be important for patient selection and in managing surgical expectations.
Methods
PAT was prospectively quantified on axial imaging by measuring its area at the level of the hilum. Wilcoxon and Chi-square univariate analyses and linear model or logistic regression multivariable analyses were performed to identify associations with PAT.
Results
Median PAT area was 29.1cm², 20% of our cohort had adherent PAT. Univariate analysis identified male gender, age > 60, presence of DM2 or HTN, higher BMI, ASA score > 2 and presence of metabolic syndrome to predict greater amounts of PAT.  On multivariate analysis the presence of metabolic syndrome remained a significant predictor of PAT amount and confirmed that PAT amount greater than 30 mm², male gender, age greater than 60 and higher BM correlate with presence of adherent fat. Increased PAT as well as presence of adherent PAT were significant predictors of operating room time, but not of major (Clavien grade 3-5) or overall complications, warm ischemia time or length of stay. 
Conclusions
Non-modifiable risk factors such as age and gender, as well as modifiable risk factors, such as HTN, DM2, and BMI are associated with increased amounts of PAT, thereby increasing the complexity and duration of partial nephrectomy.  The presence of metabolic syndrome is associated with increased PAT, a finding not previously described, and should be considered during complex partial nephrectomy counseling.