Impact of operative time on complications after PCNL in the elderly (aged ≥70 years): the Safety and Efficacy of Nephrolithotomy in Older patients undergoing PCNL (SENIOR-PCNL) study.

Abstract

Objectives: To evaluate the association between operative time (OT) and postoperative complications after percutaneous nephrolithotomy (PCNL) in elderly patients, and to identify a clinically meaningful OT threshold for risk stratification.

Patients and methods: A retrospective international multicentre study was performed including patients aged ≥70 years who underwent PCNL between January 2014 and February 2025 across 21 centres in 15 countries. Postoperative complications within 30 days were analysed as overall, major, and infectious events. The optimal OT threshold was determined using receiver operating characteristic (ROC) analysis, whereas the association between OT and postoperative outcomes was evaluated using multivariable logistic regression and adjusted restricted cubic spline models.

Results: Among 716 patients, 120 (16.8%) developed postoperative complications; 49 (6.8%) had major and 49 (6.8%) infectious complications. ROC analysis identified a common OT threshold around 95 min. An OT ≥95 min was independently associated with overall complications (odds ratio [OR] 3.37, 95% confidence interval [CI] 2.16-5.26), major complications (OR 2.63, 95% CI 1.35-5.10), and infectious complications (OR 3.79, 95% CI 1.90-7.57). The highest discriminative performance was observed for infectious complications (multivariable model area under the curve 0.77). Restricted cubic spline analysis confirmed significant non-linear associations between OT and all outcomes, with a steeper increase in adjusted complication probability beyond approximately 90-100 min. Non-papillary puncture was independently associated with all complication types, while positive preoperative urine culture predicted infectious complications.

Conclusions: In elderly patients undergoing PCNL, prolonged OT was independently associated with higher odds of overall, major, and infectious postoperative complications. The relationship was non-linear, with a clinically relevant threshold around 95 min, supporting OT as a practical intraoperative marker for risk stratification and procedural planning.