Complication risks in elderly patients undergoing percutaneous nephrolithotomy compared to younger populations

This systematic review and meta-analysis evaluated the clinical outcomes of percutaneous nephrolithotomy (PCNL) in elderly patients compared to non-elderly populations. The analysis included a total of 45,603 patients, of which 10,745 were identified as elderly individuals. The study utilized various age thresholds to define the elderly population, including 60, 65, or 70 years. The researchers examined the association between patient age and several key outcomes, including overall, minor, and major complications, as well as the stone-free rate (SFR).

When pooling data across all age definitions, the meta-analysis found no significant difference in overall complications between elderly and younger patients, reporting an odds ratio (OR) of 1.20 (95% CI 0.95-1.53). Similarly, no significant difference was observed for major complications, with an OR of 1.39 (95% CI 0.92-2.10). The stone-free rate (SFR) was also found to be comparable between the two groups. However, a critical finding was the significantly higher risk of postoperative sepsis in elderly patients, which demonstrated an OR of 3.94 (95% CI 1.83-8.47).

Subgroup analyses revealed that the impact of age may depend heavily on the specific age threshold used for classification. When using an age cut-off of 70 years, the data indicated a significantly increased risk for both overall complications (OR 1.26, 9SS CI 1.03-1.55) and major complications (OR 1.95, 95% CI 1.15-3.31) in the elderly group. Conversely, when the age cut-offs were set at 60 or 65 years, no significant differences in overall or major complications were observed between the elderly and non-elderly cohorts.

Regarding safety and tolerability, the study focused on the incidence of overall, minor, and major complications, specifically highlighting postoperative sepsis as a serious adverse event. While the pooled data across all definitions suggested stability in many complication types, the increased risk of sepsis and the heightened risk profile for patients aged 70 years or older represent important safety considerations for the surgical team. The study does not report data on discontinuation rates or general tolerability.

These findings suggest that PCNL can be performed safely in elderly patients, as the stone-free rate and many complication profiles remain comparable to younger individuals when data are pooled across all age definitions. However, the results also indicate that overall and major complications increase progressively with advancing age, particularly among patients aged 70 years and older. This highlights a potential shift in the risk-benefit ratio as patients move into older age brackets.

It is important to note that this study is a meta-analysis of observational and comparative studies, meaning it reports associations rather than direct causation. The certainty of the evidence was not explicitly reported in the provided data. Clinical decisions should be based on the specific age-related risks identified, particularly the increased risk of sepsis and major complications in the oldest subgroup. Further research is needed to determine the specific clinical drivers of the increased sepsis risk in this population.