Can we avoid percutaneous nephrolithotomy in high-risk elderly patients using the Charlson comorbidity index? - Abstract

OBJECTIVE:To determine whether Charlson comorbidity index (CCI) predicts the postoperative complications after percutaneous nephrolithotomy (PCNL) and could be a plausible option to avoid surgery and its potential risks in elderly patients with significant comorbidites.

METHODS: The data from 283 elderly patients (age ≥60 years) who underwent PCNL in 4 large referral hospitals were reviewed in the present multicenter study. For each patient, we evaluated pre-existing comorbidities and calculated the CCI score. The patients were classified to 3 CCI score categories (0, 1, ≥2) and compared regarding the stone-free and complications rates.

RESULTS: The mean patient age was 64.7, 65.6, and 67.7 years in the 3 groups. The stone-free rate after primary PCNL was 85.7% in group 1, 86.1% in group 2, and 75.0% in group 3. These rates increased to 90.8%, 95.4%, and 83.9% after a second intervention (P = .049). The overall postoperative complication rate was 38.8%. The most common complication was hemorrhage necessitating blood transfusion in 34 patients (12%), and we found an increased risk of hemorrhage associated with the CCI score (P = .011). Life-threatening medical complications developed in 7.6% of the patients in group 1, 12% of the patients in group 2, and 28.6% of the patients in group 3 (P = .001). A multivariate logistic regression analysis showed that a high CCI score, bleeding, and operative time had significant influence on the postoperative medical complication in this population.

CONCLUSION: Conservative management of asymptomatic large kidney stones appears to be a safe alternative to PCNL in elderly patients with significant comorbidites.

Written by:
Resorlu B, Diri A, Atmaca AF, Tuygun C, Oztuna D, Bozkurt OF, Unsal A. Are you the author?
Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey.

Reference: Urology. 2012 May;79(5):1042-7.
doi: 10.1016/j.urology.2011.10.060

PubMed Abstract
PMID: 22196410

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