Outcomes following surgical management of urinary stone disease in older patients

Background: The prevalence of urinary stone disease (USD) is increasing among older patients. Data examining the association between patient age and clinical outcomes following surgical treatment for USD are limited. Our objective was to assess the safety profiles of ureteroscopy (URS), extracorporeal shock wave lithotripsy (ESWL), and percutaneous nephrolithotomy (PCNL) for USD by age in an older patient population. Methods: We retrospectively identified all patients who underwent URS, ESWL, and PCNL for USD from 2010 to 2019 in the Veterans Health Administration. We fit multivariable logistic regression models to determine the association between age and post-procedure sepsis, hospital readmission, and all-cause mortality within 30 days of admission. Results: We identified 50,519 procedures for USD, including 41,216 URS (81.6%), 5741 ESWL (11.4%), and 3562 PCNL (7.1%). Overall, increasing age was associated with post-operative sepsis (aOR per five-year increase 1.02; 95% CI: 1.00–1.05), hospital readmission (aOR = 1.02, 95% CI: 1.01–1.04), and all-cause mortality within 30 days (aOR = 1.19, 95% CI: 1.10–1.29). Among URS cases, increasing age was significantly associated with sepsis (aOR = 1.03, 95% CI: 1.00–1.05), hospital readmission (aOR = 1.03, 95% CI: 1.01–1.05), and all-cause mortality (aOR = 1.19, 95% CI: 1.09–1.30) within 30 days. We detected no association between increasing age and adverse outcomes following ESWL or PCNL. Limitations include a lack of data on the type of stone disease and analysis of predominantly older male veterans, potentially limiting generalizability. Conclusions: Following URS, age was independently associated with sepsis, hospital readmission, and all-cause mortality within 30 days of admission. This association was not found in patients who underwent ESWL or PCNL. Additional preoperative risk counseling and medical optimization may be beneficial in older patients undergoing URS.