Early laparoscopic cholecystectomy in very elderly patients: a propensity score-matched analysis of a nationwide registry

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Background: The role of early laparoscopic cholecystectomy (ELC) in very elderly patients with acute calculous cholecystitis (ACC) is still controversial. The aim of this study is to assess the safety of ELC for ACC in ≥85-year-old patients. Methods: Multicentric retrospective analysis of patients who underwent ELC for ACC between 2013-2018. Patients ≥85-year-old were assigned to group 1, those younger to group 2. The two groups were compared before and after propensity-score matching (PSM). The main outcomes were post-operative complications, length of stay, and readmissions. Results: The study included 1670 subjects. The unmatched comparison revealed a selection bias towards group 1, that was associated with higher Charlson Comorbidity Index (5 vs 1, p<0.001), more ASA III/IV patients (54.2% vs 19.3%, p<0.001), diabetes mellitus (36.8% vs 19.1%, p<0.001), previous abdominal surgery (39.6% vs 27.4%, p=0.010), previous percutaneous cholecystostomy (13.2% vs 2.4%, p<0.001), perforated gallbladder on preoperative imaging (14.4% vs 6.3%, p=0.005) and grade II/III ACC (80.1% vs 69.1%, p=0.016). Group 1 patients also required more conversion to open surgery (20% vs 10.3%, p=0.005) and subtotal cholecystectomy (9.3% vs 3.4%, p=0.012). After the PSM (n=206 patients) the two groups were comparable in terms of baseline characteristics and intraoperative outcomes, with a model exhibiting good discrimination and calibration. No significant differences were observed in total postoperative complications, bile leak, incisional, intrabdominal, urinary and respiratory tract infections, length of stay, and readmissions. Conclusions: ELC for ACC seems safe in selected ≥85-year-old patients. Age itself should not be regarded as a contraindication to surgery with ELC.