Management of acute cholecystitis in patients older than the expected life expectancy: Is the Tokyo Guidelines 2018 still practical?

Abstract

Abstract Background As the global population ages, the incidence of acute cholecystitis is increasing. Tokyo Guidelines 2018 are established as the standard for managing this condition. However, the applicability in elderly patients, who often have comorbidities and higher surgical risks, is uncertain. This study assesses the feasibility of using the guidelines to manage acute cholecystitis in patients aged 85 and older. Methods We conducted a retrospective analysis on patients aged ≥ 85 diagnosed with acute cholecystitis between 2011 and 2021. Patient demographics, disease severity, comorbidities, and treatment outcomes were examined. Patients were categorized into three groups based on severity and adherence to recommendations. Results Among 166 elderly patients with acute cholecystitis, guideline compliance varied by severity. Adherence to the guidelines resulted in better outcomes, including shorter hospital stays and fewer complications, for mild (group I) and moderate (group II) cases. Severe cases (group III) had similar outcomes regardless of guideline adherence. Conclusions This study suggests that the Tokyo Guidelines 2018 is applicable to elderly patients aged 85 and older with acute cholecystitis. Better outcomes were observed when patients followed the guidelines, particularly in mild and moderate cases. Tailoring treatment to individual needs is paramount for optimizing outcomes in severe cases within this age group.