Association between psoas-to-lumbar vertebral index and postoperative complications in elderly patients with hip fractures
Objective To investigate the association between psoas-to-lumbar vertebral index(PLVI)and postoperative com-plications in elderly patients with hip fractures.Methods A retrospective analysis was conducted on 686 elderly patients who under-went hip fracture surgery at the 943 th Hospital of PLA Joint Logistics Support Force from March 2016 to December 2020.The cross-sectional area of lumbar muscles and the L4 vertebral body area were calculated by computed tomography(CT).PLVI was defined as the ratio between the average cross-sectional area of the left and right lumbar muscles and the L4 vertebral body area.The patients were divided into two groups according to the median value of male and female PLVI(low-PLVI group and high-PLVI group).The main outcome was complications within 6 months after operation(poor healing,delirium,pneumonia,urinary tract infection,deep vein thrombosis,heart failure,respiratory failure,sepsis).The secondary end points were 1-year mortality and total mortality.Results Complications occurred in 122 patients(17.78％)within 6 months after surgery,and PLVI was lower in these patients be-fore surgery(P<0.05).Compared with the high PLVI group,patients in the low PLVI group had a higher incidence of poor healing,delirium,and pneumonia,while serum albumin(ALB)levels were decreased and serum C-reactive protein levels were increased(P<0.05).In multivariate Logistic regression analysis adjusting for confounders,risk factors associated with chronic kidney disease(OR= 3.500,95％CI:1.484-8.252),delayed fracture to surgical interval(OR=1.711,95％CI:1.044-2.804),decreased preoperative ALB level(OR=4.922,95％CI:2.633-9.202)and low PLVI(OR=0.136,95％CI:0.074-0.249)were independent predictors of the risk of postoperative complications including poor healing,delirium,and pneumonia in elderly patients(P<0.05).According to Kaplan-Meier curve analysis,the total mortality of patients in the low PLVI group(11.37％,39/343)was higher than that in the high PLVI group(1.75％,6/343),with statistical significance(log rank=24.610,P<0.001).Conclusions Preoperative PLVI can independently predict the risk of poor healing,delirium,pneumonia and mortality after hip fracture surgery in elderly patients.
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