Management of acute cholecystitis in patients older than the expected life expectancy: Is the Tokyo guideline 2018 (TG18) still practical?

Abstract text (incl. references and figure legends)

Introduction

The Tokyo Guideline 2018 (TG18) has been accepted for managinf acute cholecystitis (AC), but the application in elderly patients is still unknown. Our aim was to investigate the feasibility of applying the TG18 to elderly patients

Material & Methods

From Jan. 2011 to Oct. 2021, 166 AC patients aged 85 years or older were treated and reviewed. The patients were divided according to the TG18 severity grading (mild, moderate, and severe AC). Within each group, the clinical outcomes were compared between those who were managed following the TG18 and those managed deviating from the TG18.

Results

Among all 166 patients, 87 (52.4%) were treated according to the TG18. For the mild AC group, the patients treated following the TG18 had a significantly shorter overall length of hospital stay (8.1 vs. 16.3 days, p < 0.001) and fewer biliary complications (0.0% vs. 32.7%, p = 0.007). For the moderate AC group, patients who were treated following the TG18 had a longer first hospitalization (11.6 vs. 7.7 days, p = 0.011) but lower ICU admission rate (10.0% vs. 38.9%, p = 0.027).

For those who underwent cholecystectomy, mild AC patients who were treated following the TG18 had a shorter operation time (111.1 vs. 145.6 minutes, p = 0.023) and could be discharged earlier after the operation (2.7 days vs. 4.6 days, p = 0.022). For the moderate AC group, a lower ICU admission rate (6.3% vs. 40%, p = 0.034) and a lower postoperative complication rate (0.0% vs. 30.0%, p = 0.046) were observed in patients who were treated following the TG18. There was no significant difference between the patients who were treated following and deviating from the TG18 in the severe AC group.

Conclusions

For elderly AC patients, our results revealed that the TG18 is still a valid guideline for treating extremely old patients with AC. Optimal outcomes can still be achieved by following the TG18 for these groups of patients.

References Tokyo Guideline 2018, Surgical endoscopy

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