Outcomes of Non-Operative Management vs Surgery in Elderly Patients with Acute Cholecystitis: A Prospective Cohort Study

Background: Acute Cholecystitis (AC) in the elderly is a common surgical emergency with a high morbidity rate. Optimal management is debatable, as surgery provides definitive treatment but may pose an increased risk in older, comorbid individuals. This study compared non-operative management to surgical treatment for elderly AC patients at a tertiary care hospital. Methods: We conducted a prospective cohort study of patients ≥ 65 years with acute calculous cholecystitis at Ayub Teaching Hospital, Abbottabad. Patients were treated non-operatively (antibiotics+percutaneous cholecystostomy) or with an early cholecystectomy based on clinical judgment. Baseline characteristics, comorbidities, and disease severity were documented. The primary outcomes were mortality and major complications. Secondary outcomes included hospital length of stay, cost, readmissions, recurrence, and 6-month quality-of-life scores. Results: The study included 120 patients (mean age 73.5 years, 52% female) (60 surgical and 60 non-operative). Surgical patients experienced lower 30-day mortality (6.7%) and 1-year mortality (16.7%) compared to non-operative patients. Major complications occurred in 25% (surgery) and 33% (non-operative). Surgery resulted in a longer index stay, fewer biliary recurrences and readmissions, and a lower cumulative one-year cost. Early cholecystectomy is recommended for fit elderly patients, as it leads to lower long-term mortality, fewer recurrences, and better overall outcomes. Conclusion: Early cholecystectomy is safe and can be beneficial in appropriately selected elderly patients, leading to reduced long-term mortality and morbidity. Non-operative care remains a necessary alternative for high-risk patients, but it should not replace definitive surgery in individuals fit for surgery.