Abstract
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<0.0001), the postoperative complication rate was significantly lower (6.3% vs. 16.7%, P=0.03), and the postoperative hospital stay was significantly shorter (7.4 vs. 8.5 days, P=0.029). Extremely elderly patients had significantly higher intraoperative blood loss (166.1 vs. 105.2 ml, P=0.04) and a significantly longer postoperative hospital stay (14.2 vs. 6.8 days; P=0.0001) compared to patients less than 85 years old, but there were no differences in the rates of Lap C (65.2% vs. 78.7%, P=0.15) and postoperative complications (13.0% vs. 7.9%, P=0.40). Conclusion: Patients with AC who underwent surgery at more than 72 hours after onset and extremely elderly patients over 85 years old had increased intraoperative blood loss and a prolonged postoperative hospital stay. Therefore, careful perioperative management may be required in these high risk patients with AC.
