Clinical Outcomes of Emergency Surgery for Acute Cholecystitis: Safety, Optimal Timing of Surgery, and Effects in Extremely Elderly Patients

Purpose: The treatment strategy for acute cholecystitis (AC) is based on clinical guidelines such as the Tokyo Guidelines 2018, and early surgery is recommended. However, we sometimes encounter patients with AC who are high risk for early emergency surgery. Materials and Methods: From November 2013 to October 2018, 201 patients with AC underwent emergency surgeries at our hospital. These patients were divided into groups based on the time from AC onset to surgery and age: (1) early cholecystectomy within 72 hours of AC onset (n=159) and delayed cholecystectomy over 72 hours after AC onset (n=42); and (2) extremely elderly patients over 85 years old (n=23) and patients less than 85 years old (n=178). Clinical outcomes were compared for each of these groups. Result: In patients with early cholecystectomy, the rate of laparoscopic cholecystectomy (Lap C) was significantly higher (82.4% vs. 57.1%, P=0.0005), intraoperative blood loss was significantly lower (92.9 vs. 185.1 ml, P