CT Evaluation of Pectoralis Major Muscle Parameters in Predicting Postoperative Pulmonary Complications in Elderly Patients with Rib Fracture

Abstract

Objective To investigate the predictive value of CT evaluation of pectoralis major muscle parameters for pulmonary complications after rib fracture surgery in the elderly. Methods A total of 105 elderly patients who underwent surgical treatment for rib fracture at Tianjin Hospital in Tianjin, China, from January 2021 to October 2023 were selected. Postoperatively, patients were divided into a complication group (28 cases) and a non-complication group (77 cases) based on whether pulmonary complications occurred. Upon admission, general information such as gender, age, height, smoking history, presence of underlying respiratory diseases, and disease course were recorded for both groups. The pectoralis major index and density(PMI, PMD) were measured using CT scans.Multivariate logistic regression analysis was used to investigate the predictive value of general patient information and pectoralis major muscle parameters for postoperative pulmonary complications in elderly patients with rib fracture. Results Postoperative pulmonary complications occurred in 28 patients (26.7%). Univariate logistic regression model analysis showed that age ≥ 70 years, smoking history, history of underlying pulmonary diseases, disease duration ≥72 hours, and rib fractures ≥5 could lead to postoperative pulmonary complications in elderly patients with rib fractures (P<0.05); multivariate logistic regression analysis showed that age ≥70 years, smoking history, history of underlying pulmonary diseases, disease duration ≥72 hours, and number of rib fractures ≥5, bilateral rib fractures and PMI and PMD were all independent risk factors leading to postoperative pulmonary complications in elderly patients with rib fractures (P<0.05). The results of ROC curve analysis showed that the area under the curve of PMD in predicting pulmonary complications after rib fracture surgery was 0.832(95% CI: 0.746-0.918), and the area under the curve of PMI in predicting pulmonary complications after rib fracture surgery was 0.732(95% CI: 0.773-0.937), both of which had a good predictive effect on whether pulmonary complications occurred after rib fracture surgery in patients. Conclusion Assessing pectoralis major muscle parameters by CT is an effective tool to predict whether patients develop pulmonary complications after surgery, and timely adjustment of patients’ treatment options according to patients’ prediction results is of great significance in improving patients’ prognosis.

Keywords

• rib fracture
• pulmonary complication
• pectoralis major index
• pectoralis major density