A systematic review and meta-analysis of the diagnostic value of ultrasound measurement of m. rectus femoris thickness for predicting postoperative complications in surgical patients

Background. Sarcopenia is a common condition in hospitalized elderly patients, associated with an increased risk of postoperative complications. Computed tomography is the gold standard for diagnosing sarcopenia, but it has a number of limitations. Ultrasound assessment of the thickness of the rectus femoris muscle is a non-invasive and affordable alternative, but its prognostic value in surgical practice has not yet been systematically evaluated.

Objective. To evaluate the diagnostic and prognostic significance of ultrasound measurement of m. rectus femoris thickness in the context of postoperative outcomes in adult patients.

Material and methods. A systematic search of the literature was conducted in the PubMed, EMBASE, Cochrane Library, Scopus, ClinicalTrials.gov, eLIBRARY.RU, and RNMB Registry databases from their inception to April 1, 2025. Fourteen studies with a total of 1.325 participants were included. Inclusion criteria: adult patients (not younger 18 years) who underwent surgery; indication of postoperative complications and ultrasound data on the thickness of the rectus femoris muscle. Studies on children and pregnant women, as well as studies with incorrect methodology, were excluded. The meta-analysis was performed using fixed and random effects models (Mantel–Haenszel, Generic Inverse Variance), and quality was assessed using the Cochrane RoB 1.0 scale.

Results. Based on the results of the meta-analysis, sarcopenia diagnosed by ultrasound of the rectus femoris muscle is associated with an increase in: the length of hospital stay by 4.96 days (95% CI [2.74–7.19]; p<0.0001), length of mechanical ventilation by 2.52 days (95% CI [0.56–4.49]; p=0.01), and 30-day mortality (OR=3.32; 95% CI [2.32–4.75]; p<0.00001).

Conclusions. Ultrasound assessment of m. rectus femoris thickness is a promising tool for preoperative risk stratification. The method demonstrates high clinical significance in predicting complications. Further high-quality RCTs are needed to standardize techniques and validate ultrasound in clinical practice.

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