Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population

Zain A. Abedali, Tim Large, Joshua M. Heiman, Elhaam Bandali, Blake B. Anderson, James E. Lingeman, Amy E. Krambeck

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Jan 1 2019

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Percutaneous Nephrostomy
Population
Hemoglobins
Nephrolithiasis
Research Ethics Committees
Analysis of Variance
Hospitalization
Age Groups
Databases
Hemorrhage
Survival

ASJC Scopus subject areas

  • Urology

Cite this

Abedali, Z. A., Large, T., Heiman, J. M., Bandali, E., Anderson, B. B., Lingeman, J. E., & Krambeck, A. E. (Accepted/In press). Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population. Urology. https://doi.org/10.1016/j.urology.2019.08.044

Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population. / Abedali, Zain A.; Large, Tim; Heiman, Joshua M.; Bandali, Elhaam; Anderson, Blake B.; Lingeman, James E.; Krambeck, Amy E.

In: Urology, 01.01.2019.

Research output: Contribution to journalArticle

Abedali ZA, Large T, Heiman JM, Bandali E, Anderson BB, Lingeman JE et al. Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population. Urology. 2019 Jan 1. https://doi.org/10.1016/j.urology.2019.08.044
Abedali, Zain A. ; Large, Tim ; Heiman, Joshua M. ; Bandali, Elhaam ; Anderson, Blake B. ; Lingeman, James E. ; Krambeck, Amy E. / Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population. In: Urology. 2019.
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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.",
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AB - 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.

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