73 The Hot Gallbladder in Elderly: Outcomes of Emergency Cholecystectomy in the Elderly

Abstract Background Acute gallbladder pathology requiring emergency cholecystectomy is common in the elderly. Old age (≥65 years) by itself is not a contraindication for surgical management of acute cholecystitis. This study aimed to compare perioperative outcomes between elderly (≥65) and younger (<65) patients undergoing emergency laparoscopic cholecystectomy. Method We conducted a retrospective analysis of patients undergoing emergency laparoscopic cholecystectomy at our center from 2013 to 2024. Patients were stratified into two groups: elderly (≥65 years, n=223) and younger (<65 years, n=562). Results A total of 785 patients were analyzed (223 elderly vs 562 younger). Elderly patients had significantly more comorbid conditions (e.g., hypertension in 65.9% vs 18.3%, diabetes in 37.6% vs 14.9%; p<0.001) and higher ASA class (ASA ≥III in ∼52% vs 9% of cases). They also more frequently presented with complicated gallbladder disease, such as gangrenous cholecystitis (5.4% vs 2.3%, p<0.05) and gallbladder empyema (9.4% vs 4.4%, p=0.01). Despite these risks, 92.4% of elderly patients were successfully treated laparoscopically (conversion rate 7.6% vs 3.9% younger, p=0.048). Postoperative complications were more frequent in the elderly, with an overall complication rate of 22.0% compared to 8.9% in younger patients (p<0.001). Wound infection (2.2% vs. 1.1%), retained stones (5.4% vs. 2.5%, p=0.07), and postoperative bleeding (3.1% vs. 2.0%) were all slightly more common but did not reach statistical significance. Thirty-day readmission rates were similar (9.9% vs. 7.5%; p=0.341). Conclusions Our findings support offering timely laparoscopic cholecystectomy to elderly patients with acute gallbladder disease, emphasizing that age alone should not preclude definitive surgical treatment.