Association of the Controlling Nutritional Status Score with the Development of Postoperative Paralytic Ileus After Radical Cystectomy: Retrospective Cohort Study

Abstract

OBJECTIVE: Postoperative paralytic ileus is a major adverse event of radical cystectomy, causing prolonged hospitalization. The controlling nutritional status score, consisting of serum albumin, total lymphocyte count, and total cholesterol, indicates the nutritional status and may evaluate gastrointestinal status. This study aimed to clarify the association between the controlling nutritional status score and the development of postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder. MATERIALS AND METHODS: We retrospectively analyzed the clinical features of patients who underwent open radical cystectomy or robotic assisted laparoscopic radical cystectomy with ileal conduit or ileal neobladder for bladder cancer between April 2011 and May 2021. The association between clinical variables, including the controlling nutritional status score and the development of postoperative paralytic ileus, was examined. RESULTS: Out of 133 patients, 34 (26%) developed postoperative paralytic ileus. The patients who developed postoperative paralytic ileus were likely to have a higher controlling nutritional status score (P = .055) compared to those who did not develop postoperative paralytic ileus. Multivariate analysis revealed that a preoperative controlling nutritional status score of ≥1 (odds ratio: 2.90, 95% CI: 1.08-7.80, P = .034) and longer operating time (odds ratio: 3.02, 95% CI: 1.13-8.11, P = .027) were significant independent factors for postoperative paralytic ileus development. CONCLUSION: A high controlling nutritional status score and long operating time may be risk factors for developing postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder for bladder cancer. Preoperative controlling nutritional status may be able to predict postoperative paralytic ileus development.