Early laparoscopic cholecystectomy in oldest-old patients: a propensity score matched analysis of a nationwide registry

Marcello Di Martino*, Álvaro Gancedo Quintana, Víctor Vaello Jodra, Alfonso Sanjuanbenito Dehesa, Dieter Morales García, Rubén Caiña Ruiz, Francisca García-Moreno Nisa, Fernando Mendoza-Moreno, Sara Alonso Batanero, José Edecio Quiñones Sampedro, Paola Lora Cumplido, Altea Arango Bravo, Ines Rubio-Perez, Luis Asensio-Gomez, Fernando Pardo Aranda, Sara Sentí Farrarons, Cristina Ruiz Moreno, Clara Maria Martinez Moreno, Aingeru Sarriugarte Lasarte, Mikel Prieto CalvoDaniel Aparicio-Sánchez, Eduardo Perea Perea del Pozo, Gianluca Pellino, Elena Martin-Perez

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review


The role of early laparoscopic cholecystectomy (ELC) in “oldest-old” 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. Multicentric retrospective study that analysed data of patients who underwent ELC for ACC between 2013 and 2018. Patients ≥ 85-year-old (oldest-old patients) were compared with younger patients, before and after propensity score matching (PSM). The main outcomes were mortality, post-operative complications, length of stay (LOS), and readmissions. The study included 1670 patients. The unmatched comparison revealed a selection bias towards the oldest-old group, which was associated with higher Charlson Comorbidity Index (5 vs 1, p < 0.001), more ASA III/IV subjects (54.2% vs 19.3%, p < 0.001), class II/III ACC (80.1% vs 69.1%, p = 0.016) and higher Chole-Risk Score (p > 0.001). The oldest-old also required more conversion to open surgery (20% vs 10.3%, p = 0.005). Postoperatively, they had a higher 90-day mortality rate (7.6% vs 1%, p < 0.001), more total complications (40.6% vs 17.7%, p < 0.001), complications ≥ IIIa Clavien–Dindo (14.4% vs 5.8%, p = 0.002), longer LOS (6 vs 5 days, p < 0.001), and more readmissions (6.6% vs 2.6%, p < 0.001). After PSM (n = 206), the two groups were comparable in terms of baseline characteristics and intraoperative outcomes. No differences were observed in post-operative complications; bile leak; incisional, intrabdominal, urinary or respiratory tract infections; LOS or readmissions. In the oldest-old, ELC for ACC is still associated with significant morbidity and mortality. However, it seems to be safe in selected patients. Therefore, age itself should not be regarded as a contraindication to ELC for ACC.

Original languageEnglish
Pages (from-to)979-989
Number of pages11
JournalUpdates in Surgery
Issue number3
Publication statusPublished - Jun 2022


  • Acute calcolous cholecystitis
  • Cholecystectomy
  • Cholecystitis
  • Early laparoscopic cholecystectomy
  • Elderly


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