Abstract: Objective: To explore the correlation and predictive value of shear wave elastography (SWE) of the femoris rectus and thoracoscopic postoperative pulmonary complications (PPCs). Methods: A total of 292 patients undergoing thoracoscopic surgery were selected as the study objects,and their clinical data were collected. The patients were separated into two groups: one for PPCs and the other for non-PPCs, based on the incidence of PPCs following surgery. The rectus femoris thickness (RFthick), cross-sectional area (RFcsa), and shear wave elastography velocity mean (CSmean) were assessed during the preoperative assessment of the muscle using conventional ultrasound mixed with SWE. The variables linked to the occurrence of PPCs were examined, and the differences in clinical data and the rectus femoris parameters between the two groups were evaluated. The logistic regression analysis was used to derive a combined diagnostic formula, and the ROC curve was plotted to further analyze the predictive value of single and combined indicators for PPCs. Results: The occurrence of PPCs was correlated with age and the rectus femoris CSmean (positively correlated with age, negatively correlated with CSmean, P<0.001). Age and CSmean alone had low predictive efficacy for PPCs, while the combination of the two indicators had higher predictive efficacy (AUC=0.714). Conclusion: Analysis of the rectus femoris CSmean can predict the occurrence of PPCs, and it has higher predictive value combined with age index, which can evaluate the risk of PPCs in patients undergoing thoracoscopic surgery in a non-invasive and rapid manner.