Ureteroscopy for Stone Disease in Extremely Elderly Patients (≥85 Years): Outcomes and Lessons Learned

Abstract

Introduction The volume of surgeries including ureteroscopy (URS) performed for urolithiasis is increasing. This includes for the elderly population. The aim of this study was to evaluate the outcomes of URS in extremely elderly patients and identify any lessons that could be learned for clinical practice and treatment planning. Methods Retrospective analysis was performed of consecutive patients aged 85 years and older undergoing URS between 2010-2022 at our tertiary centre. Uni- and multivariable logistic regression analysis was performed to identify possible risk factors for complications Survival analysis, stratified by age-adjusted Charlson Comorbidity index (ACCI), was performed using Kaplan-Meier method as well as the log-rank test. Results 64 URS procedures were performed on 51 patients (mean age 88, range 85-97). Mean ACCI score was 7 (range 4-13) and most patients were ASA 3 (78%). Mean operative time and hospital stay were 60 minutes (range 15-120) and 2 days (range 0-6), respectively. At 3 month follow up imaging, 92% were stone free (zero fragments). Intra-operative complication rate was 14% and in three cases (5%), early termination of the procedure was necessary. Eight patients (13%) suffered a complication prior to discharge. Eighteen patients (28%) had documented late complications after their surgery. The complication rate when combining early and late adverse events was 41%. One year mortality rate was 23%. Multivariable regression analysis revealed that operation time and ACCI >7 were significant predictors of complications after surgery. Survival probability was significantly worse in those patients with ACCI > 7 (p = 0.0083). Conclusion The morbidity burden of URS in the extremely elderly is higher than for other population groups. Risk should be considered carefully and implementation of ACCI can aid this process. High scores should prompt strong consideration of a conservative approach. Operation time should be kept to a minimum wherever possible.