TOPLINE

Among older patients who underwent percutaneous nephrolithotomy (PCNL), the operative time of at least 95 minutes was associated with increased odds of complications within 30 days post-surgery.

METHODOLOGY

• Researchers conducted a retrospective study including 716 patients aged 70 years or older who underwent PCNL for renal calculi or upper ureteric calculi (2014-2025) at 21 centers from 15 countries to assess the link between duration of the operation and complications post-surgery.
• They analyzed postoperative complications occurring within 30 days and categorized them as overall (Clavien-Dindo grade I-V), major (Clavien–Dindo grade III-V), and infectious (postsurgical urinary tract infection or sepsis) complications.
• Operative time was documented as the time spanning from renal puncture to procedure completion, including the placement of a nephrostomy tube, tubeless tract closure, or ureteric stenting.
• Receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory ability of operative time, and the optimal operative time threshold was determined.

TAKEAWAY

• Overall, 16.8% developed a postoperative complication; 6.8% had major complications and an equal proportion developed infectious complications.
• ROC assessment identified cutoffs ranging from 93 min to 95 min, demonstrating sensitivities in the range of 0.67-0.71 and specificities in the range of 0.58-0.61, with consistently elevated negative predictive values at 90.6%-96.7%; a cutoff of 95 min was selected.
• In multivariable analysis, an operative time of at least 95 minutes was independently associated with higher odds of overall complications (odds ratio [OR], 3.37; P < .001), major complications (OR, 2.63; P = .004), and infectious complications (OR, 3.79; P < .001).
• Nonpapillary puncture was independently associated with all complication types (overall: OR, 2.14; P = .018; major: OR, 2.76; P = .008; infectious: OR, 3.35; P = .001); a positive preoperative urine culture predicted infectious complications (OR, 2.40; P = .005).

IN PRACTICE

"[B]ased on our findings, excessively conservative OT [operative time] thresholds do not necessarily need to be applied even in a more vulnerable geriatric population; however, the acceptable procedure duration should always be individualised according to the patient's clinical condition, frailty status, comorbidity burden, and overall operative complexity," the authors wrote. "From a practical perspective, the approximately 95-min threshold should not be interpreted as a rigid stopping rule, but rather as an intraoperative checkpoint prompting reassessment of the balance between further stone clearance and cumulative procedural risk," they added.

SOURCE

The study was led by Łukasz Nowak of the Department of Minimally Invasive and Robotic Urology in the University Centre of Excellence in Urology at Wroclaw Medical University in Wroclaw, Poland. It was published online on September 21 in BJU International.

LIMITATIONS

Perioperative care approaches, operative methods, antibiotic protocols, and documentation practices lacked complete standardization among the participating centers. Intraoperative stone samples and urine cultures from the renal pelvis were not collected routinely, limiting the evaluation of the microbiological pathways driving infectious complications. Data on the experience of operators and trainee participation were unavailable.

DISCLOSURES

The study did not receive any specific funding. No conflicts of interest were declared by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.