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The masseter muscle thickness is a predictive marker for postoperative pneumonia after endovascular aneurysm repair

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Abstract

Purpose

Oral frailty is characterized by a decrease in the oral and swallowing function and is a risk factor for pneumonia. In the current study, we analyzed the association between the masseter muscle thickness (MMT) and postoperative pneumonia and mortality after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm.

Methods

Overall, 247 patients were retrospectively evaluated. The primary end point was postoperative pneumonia. The MMT was measured as the maximum thickness of the masseter muscle 2 cm caudal to the zygomatic arch using computed tomography images obtained within 3 months before EVAR. Pneumonia was defined as the presence of progressive infiltrates, consolidation, or cavitation on imaging and a fever or leukocytosis.

Results

Twenty (8.1%) cases of postoperative pneumonia occurred within 1 year after EVAR. We found that patients with a low MMT (≤ 30th percentile: males, 10.4 mm; females: 8.8 mm) had a significantly higher risk of developing postoperative pneumonia within 1 year after elective EVAR than those with a high value. A comparison of the utility of the MMT and psoas muscle index (PMI) for predicting the 1-, 3-, and 5-year all-cause mortality revealed that the MMT had superior predictive performance.

Conclusion

The MMT before elective EVAR predicted postoperative pneumonia and life expectancy, and its predictive performance was superior to that of the PMI.

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Acknowledgements

We appreciate the radiology technicians (Mr. Tetsuya Iida and Mr. Takashi Nozawa) for preparing and evaluating the CT scan data. This work was supported by the Japanese Grants-in-Aid for Scientific Research/JSPS KAKENHI Grant (19K18194), the Japan Arteriosclerosis prevention fund research grant, and the Japan Heart Foundation Research Grant.

Funding

This work was supported by the Japanese Grants-in-Aid for Scientific Research/JSPS KAKENHI Grant (19K18194), the Japan Arteriosclerosis prevention fund research grant, and the Japan Heart Foundation Research Grant.

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Authors and Affiliations

  1. Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Tokyo, Japan

    Eisaku Ito, Hikaru Nakagawa & Naoki Toya

  2. Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-city, Tokyo, 105-8471, Japan

    Takao Ohki

Authors
  1. Eisaku Ito
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  2. Takao Ohki
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  4. Naoki Toya
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Contributions

EI and HN contributed to the study design, data acquisition, analysis, and interpretation and drafted the manuscript. NT contributed to the data analysis and critical revision of the manuscript. TO contributed to the study conception and design, data interpretation, and critical manuscript revision and gave final approval. All authors gave their final approval and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Takao Ohki.

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Conflict of interest

Takao Ohki received advisory fees from W.L. Gore and Boston Scientific Corporation. The other authors do not have conflicts of interest or financial ties to disclose.

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Supplementary Information

Below is the link to the electronic supplementary material.

595_2022_2506_MOESM1_ESM.pptx

Supplemental Figure 1. The linear regression model for the psoas muscle index and masseter muscle thickness shows a significant correlation (r=0.3145, p<0.001) (PPTX 315 kb)

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Ito, E., Ohki, T., Nakagawa, H. et al. The masseter muscle thickness is a predictive marker for postoperative pneumonia after endovascular aneurysm repair. Surg Today 52, 1591–1598 (2022). https://doi.org/10.1007/s00595-022-02506-7

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  • DOI: https://doi.org/10.1007/s00595-022-02506-7

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