Beyond age: Outcomes and predictors of complications after endoscopic lithotripsy in patients ≥ 85 years old.

Abstract

Introduction: We aimed to evaluate the effectiveness and safety of endoscopic lithotripsy in patients aged ≥85 years in a high-volume tertiary center.

Materials and methods: A retrospective analysis was conducted on patients aged ≥85 years who underwent endoscopic lithotripsy between 2009-2025. Preoperative, intraoperative, and postoperative variables were analyzed. Multivariate logistic regression was used to identify factors associated with complications.

Results: Sixty-five patients were included; the median age was 87 years, with a median age-adjusted Charlson Comorbidity Index (aCCI) of 5, and 75.4% had ASA ≥ 3. The median stone size was 11.5 mm. Procedures performed included ureteroscopy (URS) (55.4%), retrograde intrarenal surgery (RIRS) (36.9%), percutaneous nephrolithotomy (PCNL) (4.6%), endoscopic combined intrarenal surgery (ECIRS) (1.5%), and antegrade URS (1.5%). The median operative time and hospital stay were 93.5 min and 2 days, respectively. Postoperative complications occurred in 47.7% of patients, most commonly fever (n = 16) and sepsis (n = 12). Three patients experienced Clavien-Dindo IVa complications, and two died due to septic shock. The stone-free rate (SFR) was 75.4%. Longer operative time (OR = 1.034, p = 0.001) and higher aCCI (OR = 1.716, p = 0.027) were significantly associated with complications. ROC analysis showed operative time ≥73 min and aCCI ≥5 were optimal cut-off points for developing complications, yielding high sensitivity (86.7% and 90.0%) but modest specificity (47.1% and 29.4%).

Conclusions: Endoscopic lithotripsy in patients aged ≥85 years is feasible and achieves satisfactory SFR; however, it carries substantial risk of postoperative complications, including potentially life-threatening events. Patient selection based on comorbidity burden is essential. Operative time was associated with complications; although it may reflect procedural complexity, efforts to optimize surgical efficiency may help reduce postoperative complications in this vulnerable population.