Sarcopenia Is Associated with Worse Perioperative Outcomes in Elderly Patients after Percutaneous Nephrolithotomy

Abstract

Introduction:

Sarcopenia, the generalized loss of muscle mass, has been linked to outcomes across various medical specialties, but remains understudied in Endourology. This study aimed to evaluate whether sarcopenia serves as a prognostic indicator in elderly patients undergoing percutaneous nephrolithotomy (PCNL).

Patients and Methods:

Patients ≥70 years who underwent PCNL between January 2021 and December 2022 were identified retrospectively. Sarcopenia was determined using preoperative CT. Postoperative outcomes were compared between sarcopenic patients and non-sarcopenic controls.

Results:

A total of 234 patients were included, with 148 (63%) meeting criterion for sarcopenia. There was no difference in mean age, co-morbidities, or cumulative linear stone burden (18.8 mm vs. 20.5 mm, p = 0.21) between the groups; however, sarcopenia was significantly more prevalent among men compared to women (77% vs 47.2%, p < .001). Patients with sarcopenia experienced higher rates of Clavien–Dindo grade ≥2 complications (20% vs 8%, p = 0.02) compared to controls and trended toward higher rates of perioperative transfusions (7% vs 1%, p = 0.06). Unanticipated ED visits were higher among patients with sarcopenia (24% vs 9%; p = 0.01). On multivariate analysis, patients with sarcopenia were 2.8 times more likely to experience complications (odds ratio = 2.78, p = 0.024) and had a 43% longer hospital stay (time ratio = 1.43, p = 0.01).

Conclusions:

Sarcopenia is associated with less favorable perioperative outcomes in elderly patients undergoing PCNL, with higher complication rates, increased emergency room visits, and prolonged hospital stays. We present a novel risk-stratification tool to help identify patients at increased risk of adverse events after PCNL, which may serve as a valuable adjunct in perioperative risk estimation and preoperative counseling in this high-risk population.