Abstract: PD21-11
Sources of Funding: None

Introduction

Growing numbers of geriatric patients present for definitive management of kidney stones. Geriatric patients with large stones may be candidates for percutaneous nephrostolithotomy (PCNL), however their care-related needs may differ from younger patients. We reviewed our PCNL experience in geriatric patients to better define surgical outcomes, complications, and discharge needs.

Methods

We retrospectively analyzed patients undergoing PCNL from 2012-2015 in our institution. Preoperative characteristics, surgical outcomes, complications, and discharge needs were compared between two groups: geriatric patients (aged ≥65 years) and non-geriatric patients (<65years). Statistical analysis was performed with students t-test and chi-squared test.

Results

We analyzed 287 consecutive patients: 89(31%) patients ≥65 years; 198(69%) patients <65 years (mean age 72 vs 48 years, p<0.001). The results can be seen in Table 1. Geriatric patients were more likely Caucasian (91% vs 73.7%, p=0.001), had fewer positive preoperative urine cultures (27% vs 41.6%, p=0.017), and had higher American Society of Anesthesiologist scores (mean 2.83 vs 2.55, p<0.001). OR time (mean 159 vs 185 minutes, p=0.003) and estimated blood loss (41 vs 56 mL, p=0.014) were less in the geriatric group. The residual stone fragment size was less after one procedure (0-2 mm: 72.9% vs 58.5%; 3-4 mm: 15.6% vs 17.5%; >4 mm: 11.5% vs 24%, p=0.024) in the geriatric group. There were no differences in 30 day readmissions (12.4% vs 12.6%, p=0.95), total complications (30.3% vs 27.3%, p=0.594) or major complications (9.0% vs 5.6% ≥ Clavien III p=0.279) between the geriatric and non-geriatric groups respectively. Length of stay (3.1 vs 3.2 days, p=0.852) was similar between the groups, however the geriatric group was more often discharged with services to assist with nephrostomy tubes or wound dressings (21.3% vs 9.1%, p=0.016)._x000D_

Conclusions

PCNL is an acceptable surgical option in appropriately selected geriatric patients. These patients require more home nursing care, but otherwise do well compared to younger patients. This information may be helpful for both patient counseling and discharge planning in the geriatric stone population.

Funding

None