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

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.

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Journal
British Journal of Urology
Published
2026-09-21
DOI
https://doi.org/10.1111/bju.70440
Primary Topic
Kidney Stones and Urolithiasis Treatments
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article
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article

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

Qi Hou, Patrick Juliebø‐Jones, Matthias Boeykens, Arman Tsaturyan et al.
British Journal of Urology
Kidney Stones and Urolithiasis Treatments
article

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

Qi Hou, Patrick Juliebø‐Jones, Matthias Boeykens, Arman Tsaturyan, Francesco Esperto, Yuigi Yuminaga, Bartosz Małkiewicz, Rıfat Burak Ergül, Bhaskar Kumar Somani, Rafael Carrasco Moreno, EVANGELOS N. LIATSIKOS, Ioannis Mykoniatis, Vineet Gauhar, Amelia Pietropaolo, Angelis Peteinaris, Steffi Kar Kei Yuen, Alba Sierra, Maria Florencia Frascheri, Tomasz Szydełko, Alberto Olivero, Begoña Ballesta Martínez, Lazaros I. Tzelves, Tarık Emre Şener, Ziv Savin, Dimitrios Memmos, Agata Góral, Vincent De Coninck, Łukasz Nowak, Mantu Gupta, Eugenio Ventimiglia, Charlotte Slots, Thomas O. Tailly, Rita Pages, Ceyhun Ozdemiroglu, Otas Durutovic, Paulina Biesiadecka, YAU Working Group Endourology & Urolithiasis and the EAU Endourology Section, Juan Serna, Francisco Javier Lopez Vivo, Anastasios Anastasiadis, Wojciech Krajewski, Panagiotis Kallidonis
article en

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.

British Journal of Urology
Uppsala University (SE), Chinese University of Hong Kong (HK), Shenzhen University (CN), National and Kapodistrian University of Athens (GR), Aristotle University of Thessaloniki (GR), Royal Perth Hospital (AU), Haukeland University Hospital (NO), Sismanoglio General Hospital (GR), Ghent University Hospital (BE), General University Hospital of Patras (GR), Ng Teng Fong General Hospital (SG), University Hospital Southampton NHS Foundation Trust (GB), State Hospital (GB), Wroclaw Medical University (PL), AZ Klina (BE), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Sivas State Hospital (TR), Hospital Clínic de Barcelona (ES), University Clinical Centre (PL), Erebouni Medical Center (AM), Institute of Nephro Urology (IN), Hospital Universitario del Vinalopó (ES), University of Hong Kong - Shenzhen Hospital (CN), Campus Bio Medico University Hospital (IT), AZ Maria Middelares (BE), AZ Delta (BE), Yerevan State Medical University (AM), Istanbul University (TR), Marmara University (TR), Icahn School of Medicine at Mount Sinai (US)
Reduced inequalities
Openalex Percentile: Top 11%
Kidney Stones and Urolithiasis Treatments
DOIOpen Access PDFOpenAlex
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