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

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 ≥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.

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).

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.