Evaluation of Age and Comorbidity as Risk Factors After Laparoscopic Urological Surgery

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Abstract
Few reports in the urological literature have focused on the growing population of elderly (65 years or older) patients. Coexistent medical conditions, which are more prevalent in elderly individuals, can confound results of outcome studies in this population. This single center, retrospective study was done to determine whether age and comorbidity are predictors of outcome in patients undergoing laparoscopic renal and adrenal surgery. From 1997 to 2001 laparoscopic radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy were performed in 399 consecutive adults. Patient demographics and preoperative, intraoperative and postoperative parameters were extracted from a prospectively designed computerized database. Risk stratification was based on preoperative American Society of Anesthesiologists (ASA) score. Additional risk stratification was constructed using the Charlson comorbidity index. Univariate and multivariate analyses were also performed. Age 65 years or older was not associated with an increased incidence of intraoperative, postoperative or late operative complications on univariate or multivariate analyses. However, patients 65 years or older were hospitalized significantly longer than those younger than 65 years (43 vs 24 hours, p = 0.02). Blood loss and the requirement for blood transfusion were associated with longer operative time, a higher incidence of intraoperative and postoperative complications on univariate analysis, and longer hospitalization. No association of blood loss with postoperative complications was noted on multivariate analysis. Patients with a higher ASA score were more likely to receive blood transfusion. On univariate analysis risk stratification using the ASA score and the Charlson comorbidity index was not associated with intraoperative or postoperative complications. However, on multivariable analysis patients with the lowest indexes were less likely to experience postoperative complications than those with the highest indexes (less than vs greater than 3, p = 0.04). The comorbidity index had a marginal association with the incidence of late complications (p = 0.06). Laparoscopic renal and adrenal surgery in patients 65 years or older is well tolerated. Age 65 years or older is predictive of a significantly increased hospital stay of approximately 1 day after major renal and adrenal laparoscopic surgery and it does not appear to increase independently the risk of intraoperative, postoperative or late operative complications.