Association of body mass index with complications after radical cystectomy: a systematic review and meta-analysis.
- 1Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Abstract
Radical cystectomy (RC) has high postoperative morbidity. Body mass index (BMI) is a modifiable factor, but its association with complications after RC remains controversial. Some studies report higher risk in obese patients, while others find no association or even a protective effect ("obesity paradox"). We conducted this review to clarify the association between preoperative BMI and overall and severe complications after RC. We searched PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, and CQVIP from inception to January 20, 2026. We included cohort studies reporting BMI as categorical variables (normal, overweight, obese) or continuous variables with overall or severe postoperative complications (Clavien-Dindo ≥ III or equivalent). Quality was assessed using the Newcastle-Ottawa Scale. Risk ratios (RRs) for categorical comparisons and adjusted odds ratios (ORs) for dose-response analysis (per 1 kg/m2 increase) were derived from random-effects models. Heterogeneity was assessed using I2. Prediction intervals (PIs) were calculated for comparisons with ≥5 studies. Nine studies (n=3,974) were included in the categorical meta-analysis and five studies (n=5,872) in the dose-response analysis. Obesity was associated with an increased risk of overall complications [RR =1.16, 95% confidence interval (CI): 1.03-1.32; I2=24.9%; 95% PI: 0.85-1.60] and severe complications (RR =1.43, 95% CI: 1.02-2.01; I2=30.1%; 95% PI: 0.83-2.46). No significant differences were observed between overweight and normal-weight patients for overall or severe complications, nor between obese and overweight patients. In the dose-response analysis, each 1 kg/m2 increase in BMI was associated with a 4% increase in overall complication risk (odds ratio =1.04, 95% CI: 1.01-1.07; I2=56.3%; P for heterogeneity =0.06). The included studies were of moderate to high quality (NOS scores 6-8). Obesity is associated with significantly increased risks of overall and severe complications after RC, with a linear dose-response relationship (4% per 1 kg/m2). No statistically significant differences were observed between overweight and normal-weight patients, nor between obese and overweight patients; importantly, these null findings should not be interpreted as equivalence. Clinically, preoperative weight optimization remains exploratory pending interventional confirmation, while overweight alone should not delay surgery. Given the observational evidence and BMI limitations, interpret these findings cautiously.
Related
- Peripherally acting μ-opioid receptor antagonists for recovery of bowel function after radical cystectomy: a systematic review and meta-analysis
- The use of artificial intelligence and wearable devices in enhanced recovery after surgery pathways following radical cystectomy: A systematic review
- Simultaneous Robot‐Assisted Distal Gastrectomy and Radical Cystectomy With a Shared Port Configuration in Situs Inversus Totalis
- Does Timing Matter? Perioperative Outcomes and Quality of Life After Early Versus Delayed Radical Cystectomy Following BCG Therapy
- Association of a multimodal perioperative nutritional/ERAS care pathway with postoperative infectious complications following radical hysterectomy for cervical cancer: a retrospective nonconcurrent cohort study
BibTeX
@article{tang2026association,
title = {{Association of body mass index with complications after radical cystectomy: a systematic review and meta-analysis.}},
author = {Wangqin Tang and Yifeng Li and Bensheng Liang and Jingyang Wang and Rumeng Qin and Siheng Li},
journal = {Translational andrology and urology},
year = {2026},
month = sep,
doi = {10.21037/tau-2026-0575},
url = {https://europepmc.org/article/MED/42997135},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association of body mass index with complications after radical cystectomy: a systematic review and meta-analysis.
AU - Wangqin Tang
AU - Yifeng Li
AU - Bensheng Liang
AU - Jingyang Wang
AU - Rumeng Qin
AU - Siheng Li
PY - 2026
DA - 2026/09/30
JO - Translational andrology and urology
DO - 10.21037/tau-2026-0575
UR - https://europepmc.org/article/MED/42997135
AB - Radical cystectomy (RC) has high postoperative morbidity. Body mass index (BMI) is a modifiable factor, but its association with complications after RC remains controversial. Some studies report higher risk in obese patients, while others find no association or even a protective effect ("obesity paradox"). We conducted this review to clarify the association between preoperative BMI and overall and severe complications after RC. We searched PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, and CQVIP from inception to January 20, 2026. We included cohort studies reporting BMI as categorical variables (normal, overweight, obese) or continuous variables with overall or severe postoperative complications (Clavien-Dindo ≥ III or equivalent). Quality was assessed using the Newcastle-Ottawa Scale. Risk ratios (RRs) for categorical comparisons and adjusted odds ratios (ORs) for dose-response analysis (per 1 kg/m2 increase) were derived from random-effects models. Heterogeneity was assessed using I2. Prediction intervals (PIs) were calculated for comparisons with ≥5 studies. Nine studies (n=3,974) were included in the categorical meta-analysis and five studies (n=5,872) in the dose-response analysis. Obesity was associated with an increased risk of overall complications [RR =1.16, 95% confidence interval (CI): 1.03-1.32; I2=24.9%; 95% PI: 0.85-1.60] and severe complications (RR =1.43, 95% CI: 1.02-2.01; I2=30.1%; 95% PI: 0.83-2.46). No significant differences were observed between overweight and normal-weight patients for overall or severe complications, nor between obese and overweight patients. In the dose-response analysis, each 1 kg/m2 increase in BMI was associated with a 4% increase in overall complication risk (odds ratio =1.04, 95% CI: 1.01-1.07; I2=56.3%; P for heterogeneity =0.06). The included studies were of moderate to high quality (NOS scores 6-8). Obesity is associated with significantly increased risks of overall and severe complications after RC, with a linear dose-response relationship (4% per 1 kg/m2). No statistically significant differences were observed between overweight and normal-weight patients, nor between obese and overweight patients; importantly, these null findings should not be interpreted as equivalence. Clinically, preoperative weight optimization remains exploratory pending interventional confirmation, while overweight alone should not delay surgery. Given the observational evidence and BMI limitations, interpret these findings cautiously.
SN - 2223-4691
ER -