Acute cholecystitis in older adults: a national registry-based study of patient outcomes

Acute cholecystitis (AC) is a common general surgical emergency. Older age is associated with higher incidence of gallstones and increasing severity of AC. Data on outcomes for older adults with AC remain sparse however.

All patients with AC presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics, comorbidities, length of stay, clinical management, in-patient mortality, and readmissions. Patients were grouped into cohorts by age range.

Overall, 20,886 admission episodes were identified, with a median age of 59 years (IQR 43-73) and 11,747 (56%) female patients; 3745 patients were in the 65-74 year group, 3239 in the 75-84 year, and 1478 in the over 85 year group. Older adults had more co-morbidities (Charlson Co-morbidity Index >3 in 440 (30%) of the over 85s, 689 (21%) of 75-84 years, 429 (11%) 65-74 years, and 421 (3%) under 65s (P<0.0001). In the over 85 years group, patients had the highest in-patient mortality rate (96 [6.5%]; P<0.0001), lowest rate of cholecystectomy (49 [3%]; P<0.0001), highest rate of percutaneous cholecystostomy use (140 [9%]; P<0.0001), and lowest rates of discharge to home (947 [64%]). Patients in the 65-74 year and 75-84 year groups also experienced poorer outcomes than those in the under 65 year group.

Increasing age is associated with worsening outcomes for patients with AC. For the oldest adults, AC is associated with significant risks of morbidity and potential loss of independence.