Preoperative metabolic–inflammatory profiles and early postoperative recovery after immediate breast reconstruction in patients with and without neoadjuvant chemotherapy: a retrospective cohort study

Background Neoadjuvant chemotherapy (NAC) may influence systemic metabolic-inflammatory status before surgery; however, the association between preoperative biomarker profiles and early recovery after immediate breast reconstruction remains incompletely understood. Methods In our retrospective study, we included 214 patients who had immediate breast reconstruction; out of them, 102 patients received NAC, and the other 112 patients didn’t. Preoperative measurements of serum albumin, C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) were performed. The main outcome was prolonged hospitalization, defined as a length of stay (LOS) greater than the cohort median of 8 days; postoperative complications were evaluated separately. Factors associated with prolonged hospitalization were analyzed using multiple logistic regression, and the model’s discrimination was assessed using receiver operating characteristic (ROC) analysis. Results Overall, 93 patients (43.5%) experienced prolonged hospitalization. Patients who received NAC were hospitalized longer than those who didn’t (8.6 ± 2.9 days vs 7.2 ± 2.4 days; P = 0.001), and NAC patients also had more complications (28.4% vs 17.0%; P = 0.045). In the multivariable analysis, NAC exposure (OR = 1.82, 95% CI: 1.08–3.05; P = 0.024) and a higher NLR (OR = 1.36, 95% CI: 1.12–1.65; P = 0.002) were independently related to longer length of stay, while a greater level of albumin was negatively related to length of stay (OR = 0.94, 95% CI: 0.90–0.98; P = 0.006). The multivariable model had fair discrimination (AUC = 0.742, 95% CI: 0.676–0.808). Conclusions Preoperative albumin and NLR levels may help identify patients at greater risk of prolonged hospitalization; further study is needed for multicenter validation.