Perioperative Outcomes of Emergency Cholecystectomy for Grade II-III Acute Cholecystitis in Elderly and Comorbid Patients at a Tertiary Center

Purpose This study aimed to describe perioperative outcomes associated with emergency cholecystectomy (EC) in elderly/high-risk patients based on Tokyo Guidelines 2018 (TG18). Methods A single-center retrospective surgical database included 2189 patients who underwent cholecystectomy between 2005 and 2025, and the study population included 550 patients who underwent EC for AC, excluding patients with elective cholecystectomy. The patients were divided into Grade I and II-III groups by AC severity. The patient characteristics and perioperative outcomes were compared between groups, and risk factors of severe postoperative complications were assessed using logistic multivariate analysis. Multiple linear regression analysis was performed to identify factors independently associated with the length of postoperative hospital stay. Results The patients with Grade I (n = 355) and those with Grade II-III (n = 195) were included. As a subgroup analysis, the Grade II-III group was divided into 2 groups: surgically low-risk patients (Low-risk, n = 82) and high-risk patients (High-risk, n = 113). The overall complication rate was approximately 15%. The rate of severe postoperative complications was 5.3%, and the 30-day mortality was zero in the entire cohort. The Grade II-III group had significantly more severe postoperative complications than the Grade I group (8.2% vs 3.7%, P = 0.028). There were no statistically significant differences in perioperative outcomes between the low-risk and high-risk groups, except for hospital stay. Multivariate analysis showed that LC (odds ratio = 0.414, P = 0.037) was associated with lower rates of severe postoperative complications. Conclusions EC may be a feasible option in selected elderly or comorbid patients with Grade II-III AC, with acceptable short-term outcomes.