Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population
| Autor: | Amy E. Krambeck, Joshua Heiman, Tim Large, James E. Lingeman, Elhaam Bandali, Zain A Abedali, Blake B. Anderson |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology MEDLINE Nephrolithotomy Percutaneous Postoperative Hemorrhage Older population 03 medical and health sciences Hemoglobins Kidney Calculi 0302 clinical medicine Older patients Risk Factors Preoperative Care Medicine Humans In patient Blood Transfusion Percutaneous nephrolithotomy Survival analysis Aged Retrospective Studies Aged 80 and over business.industry Age Factors Retrospective cohort study Length of Stay Middle Aged Survival Analysis United States 030220 oncology & carcinogenesis Cohort Feasibility Studies Female business |
| Zdroj: | Urology. 134 |
| ISSN: | 1527-9995 |
| Popis: | To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals.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.Of the 1,647 patients, median age was 46, 66, and 83, respectively (P0.0001). 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%; P0.001) 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.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. |
| Databáze: | OpenAIRE |
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