Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population.

Abstract

OBJECTIVE:

To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals.

METHODS:

From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999 to 2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes.

RESULTS:

Of the 1,647 patients, median age was 46, 66, and 83, respectively (P <0.0001). Three patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients (P = 0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group (P = 0.06). Mean preoperative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, P <.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; P = 0.02) and transfusions (2.3, 4.7, 10.2%; P <0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted.

CONCLUSION:

PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long-term survival.

• Authors: Zain A Abedali, Tim Large, Joshua M Heiman, Elhaam Bandali, Blake B Anderson, James E Lingeman, Amy E Krambeck
• Journal: Urology (Urology) Vol. 134 Pg. 62-65 (Dec 2019) ISSN: 1527-9995 [Electronic] United States
• PMID: 31536740 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Hemoglobins

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Blood Transfusion (statistics & numerical data)
• Feasibility Studies
• Female
• Hemoglobins (analysis)
• Humans
• Kidney Calculi (blood, epidemiology, surgery)
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Nephrolithotomy, Percutaneous (adverse effects, methods)
• Postoperative Hemorrhage (blood, mortality, therapy)
• Preoperative Care (methods)
• Retrospective Studies
• Risk Factors
• Survival Analysis
• United States (epidemiology)