Blood Markers May Flag Longer Hospital Stays After Immediate Breast Reconstruction

Patients undergoing immediate breast reconstruction after mastectomy often face an uncertain recovery course, and a new retrospective study suggests that routine preoperative blood tests may help identify who is most likely to experience a prolonged hospital stay. Researchers at Shanxi Cancer Hospital in Taiyuan, China, analyzed records from 214 patients who underwent immediate breast reconstruction and found that two preoperative measurements—serum albumin and the neutrophil-to-lymphocyte ratio—were independently associated with how long patients remained hospitalized after surgery.

The study, published in Frontiers in Endocrinology in the translational and clinical endocrinology section, also examined whether neoadjuvant chemotherapy, or NAC, given before surgery shaped early recovery. Of the 214 patients, 102 had received NAC prior to their reconstruction, while 112 had not. Because chemotherapy may influence systemic metabolic and inflammatory status before surgery, the researchers assessed whether preoperative biomarker profiles tracked with early postoperative outcomes.

The team measured three preoperative laboratory values: serum albumin, C-reactive protein, or CRP, and the neutrophil-to-lymphocyte ratio, or NLR. The primary outcome was prolonged hospitalization, defined as a length of stay greater than the cohort median of 8 days. Postoperative complications were evaluated separately.

Overall, 93 patients—43.5 percent of the cohort—experienced prolonged hospitalization. Patients who had received neoadjuvant chemotherapy stayed in the hospital longer than those who had not, averaging 8.6 plus or minus 2.9 days compared with 7.2 plus or minus 2.4 days, a difference that reached statistical significance at P equals 0.001. Complications were also more frequent in the NAC group, occurring in 28.4 percent of those patients versus 17.0 percent of patients who had not received chemotherapy, with P equal to 0.045.

To disentangle the effects of chemotherapy exposure from those of the biomarkers themselves, the researchers used multiple logistic regression, a statistical technique that estimates the independent contribution of each variable while accounting for the others. In this multivariable analysis, NAC exposure remained independently associated with prolonged hospitalization, with an odds ratio of 1.82 and a 95 percent confidence interval of 1.08 to 3.05, corresponding to P equals 0.024.

A higher neutrophil-to-lymphocyte ratio was also independently linked to longer hospitalization, with an odds ratio of 1.36 and a 95 percent confidence interval of 1.12 to 1.65, at P equals 0.002. Serum albumin pointed in the opposite direction: higher levels were negatively associated with length of stay, with an odds ratio of 0.94 and a 95 percent confidence interval of 0.90 to 0.98, at P equals 0.006.

To gauge how well the combined model distinguished patients who would experience prolonged hospitalization from those who would not, the researchers performed receiver operating characteristic analysis. The multivariable model achieved an area under the curve, or AUC, of 0.742, with a 95 percent confidence interval of 0.676 to 0.808. The authors characterize this as fair discrimination.

The study’s design imposes important limits on interpretation. As a retrospective, single-center cohort analysis, it can identify associations between preoperative biomarkers and recovery outcomes but cannot establish that the biomarkers cause longer or shorter stays. The cohort comes from a single institution in China, which may restrict how generalizable the findings are to other populations and health care settings. The authors note that multicenter validation is needed before any conclusions can be extended more broadly.

Even so, the results suggest that preoperative albumin and NLR levels may help identify patients at greater risk of prolonged hospitalization after immediate breast reconstruction, including among patients who undergo reconstruction following neoadjuvant chemotherapy. The authors state that further study is needed for multicenter validation before the findings can inform practice more widely.

Subject of Research: Preoperative metabolic and inflammatory biomarkers and early recovery after immediate breast reconstruction

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

Article References: Wang, F., Yang, L., Bai, W., Zhao, C., Miao, Y., Yang, W., & Liu, Y. (2026). Preoperative metabolic–inflammatory profiles and early postoperative recovery after immediate breast reconstruction in patients with and without neoadjuvant chemotherapy: a retrospective cohort study. Frontiers in Endocrinology, 17, Article 1921109. https://doi.org/10.3389/fendo.2026.1921109

Image Credits: AI Generated

DOI: 10.3389/fendo.2026.1921109

Keywords: breast reconstruction, neoadjuvant chemotherapy, neutrophil-to-lymphocyte ratio, serum albumin, C-reactive protein, length of stay, postoperative complications, retrospective cohort study, biomarkers, surgical outcomes, Preoperative, metabolic