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Introduction:
PCNL is the standard of care for large volume upper tract stone disease. Patients presenting in their seventh to ninth decade of life are often considered to be at increased risk of peri-operative complications and poorer outcomes. We aim to compare outcomes of PCNL in septuagenarian, octogenarian and nonagenarians, compared to a younger population matched for stone burden.
Materials & Methods:
Records of 231 PCNLs performed from 2006 to 2010 were reviewed. Demographics, age, ASA score, and length of stay (LOS) were assessed. Stone size, clearance, and complications were investigated. Patients over the age of 70y were compared to a stone size matched, age adjusted control group of 20 patients 30-60 years of age. Descriptive statistics and student's T-tests were used.
Results:
A total of 32 PCNLs in 28 patients over 70y (n=15 aged 71-79, 9 aged 80-89, 4 aged 90-94) were performed. This cohort's mean age was 77y, ASA of 2.63, and had 2.86 comorbidities each. The control group had a mean age of 47y, significantly lower ASA scores of 1.78, and 1.10 comorbidities (p=0.001 and p=0.0001 respectively). Stone free rate was 63.3% in those >70y and 74% in the control group, without differences in surgical time or LOS. There was no statistically significant difference in frequency of complications and mean Clavien class between the two groups.
Conclusions:
PCNL is safe and effective in patients over 70. Age, alone, should not be an excluding criterion. Concerns regarding anesthesia risk, prone positioning, bleeding and hospitalization should be considered individually.