title: Can we avoid percutaneous nephrolithotomy in high-risk elderly patients using the Charlson comorbidity index?
abstract: OBJECTIVE
  To determine whether Charlson comorbidity index (CCI) predicts the postoperative complications after percutaneous nephrolithotomy (PCNL) and could be a plausible option to avoid surgery and its potential risks in elderly patients with significant comorbidites.
  
  
  METHODS
  The data from 283 elderly patients (age ≥ 60 years) who underwent PCNL in 4 large referral hospitals were reviewed in the present multicenter study. For each patient, we evaluated pre-existing comorbidities and calculated the CCI score. The patients were classified to 3 CCI score categories (0, 1, ≥ 2) and compared regarding the stone-free and complications rates.
  
  
  RESULTS
  The mean patient age was 64.7, 65.6, and 67.7 years in the 3 groups. The stone-free rate after primary PCNL was 85.7% in group 1, 86.1% in group 2, and 75.0% in group 3. These rates increased to 90.8%, 95.4%, and 83.9% after a second intervention (P = .049). The overall postoperative complication rate was 38.8%. The most common complication was hemorrhage necessitating blood transfusion in 34 patients (12%), and we found an increased risk of hemorrhage associated with the CCI score (P = .011). Life-threatening medical complications developed in 7.6% of the patients in group 1, 12% of the patients in group 2, and 28.6% of the patients in group 3 (P = .001). A multivariate logistic regression analysis showed that a high CCI score, bleeding, and operative time had significant influence on the postoperative medical complication in this population.
  
  
  CONCLUSIONS
  Conservative management of asymptomatic large kidney stones appears to be a safe alternative to PCNL in elderly patients with significant comorbidites.
authors.affiliation: Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey. drberkan79@gmail.com
authors.forename: Berkan
authors.initials: B
authors.lastname: Resorlu
authors.forename: Akif
authors.initials: A
authors.lastname: Diri
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Atmaca
authors.forename: Can
authors.initials: C
authors.lastname: Tuygun
authors.forename: Derya
authors.initials: D
authors.lastname: Oztuna
authors.forename: Omer Faruk
authors.initials: OF
authors.lastname: Bozkurt
authors.forename: Ali
authors.initials: A
authors.lastname: Unsal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors