Preoperative CRP is a predictive factor for prolonged hospital stay after radical cystectomy for bladder cancer.

Abstract

Purpose: Radical cystectomy (RC) is a curative treatment for localized bladder cancer. We retrospectively investigated the predictive factors for prolonged hospital stay after RC, including patient characteristics, preoperative laboratory data, surgery-related factors, and postoperative complications.

Methods: We retrospectively analyzed data from 1,257 bladder cancer patients who underwent RC between 2010 and 2024: 516 open RC (ORC), 206 laparoscopic RC (LRC), and 535 robot-assisted RC (RARC). The cumulative rate of postoperative discharge (living) was calculated based on postoperative hospital stay using the Kaplan-Meier method. Multivariate analyses of factors associated with postoperative hospital stay were performed using Cox regression analysis.

Results: The median age of the cohort was 72.8 years, with 954 patients (75.9%) being male. The median preoperative C-reactive protein (CRP) level was 0.16 mg/dL (range, 0.0-28.3), and 196 patients (15.6%) had a CRP level ≥ 1.0 mg/dL. Multivariate analysis revealed that surgical procedure (RARC vs. ORC, p < 0.001; RARC vs. LRC, p < 0.001), urinary diversion type (ileal conduit vs. neobladder, p = 0.029), and preoperative CRP level (< 1.0 vs. ≥ 1.0 mg/dL, p < 0.001) were significantly associated with postoperative hospital stay. Notably, a preoperative CRP level ≥ 1.0 mg/dL remained significantly associated with postoperative hospital stay, even after adjusting for the surgical period and postoperative complications.

Conclusion: A preoperative CRP level ≥ 1.0 mg/dL was an independent predictive factor for prolonged hospital stay after RC for bladder cancer, irrespective of the surgical period, surgical procedures, and postoperative complications.