Validation of the Safe Application of Tokyo Guideline 2018 (TG18) Severity Grading and Treatment Algorithm in Super-Elderly Patients Aged 85 and Over With Acute Cholecystitis: A Study in the Japanese Tertiary Care Hospital.

BACKGROUND

With population aging and extended healthy life expectancy, the management of acute cholecystitis (AC) in patients aged ≥ 85 years has evolved. However, the Tokyo Guidelines 2018 (TG18) for AC provide no specific risk assessment criteria for this population. This study aimed to evaluate the safety of applying the TG18 surgical algorithm to super-elderly patients.

METHODS

This retrospective study compared short- and long-term outcomes between a super-elderly group (≥ 85 years, n = 60) and a younger group (70-84 years, n = 172) who underwent emergency surgery for AC.

RESULTS

In severity Grade I, no significant increase in overall (21.1% vs. 21.1%, p = 1.000) or major complications (5.3% vs. 5.6%, p = 1.000) was observed in the super-elderly group. In Grade II, there was no significant increase in overall (28.6% vs. 30.1%, p = 1.000) or major complications (10.7% vs. 6.1%, p = 0.417). There was no mortality (0% vs. 2.3%, p = 0.575) in the super elderly group across the entire cohort. Multivariate analysis revealed that dementia was a relevant risk of overall complication (OR: 6.09, p = 0.036), and Clavien-Dindo grade was a relevant risk of nonhome discharge (OR: 2.38, p = 0.012) in the super elderly group. No significant difference was observed in long-term postoperative survival between the two groups (p = 0.304).

CONCLUSIONS

In TG18 severity Grades I and II, decision-making based on the TG18 algorithm can be safely applied to super-elderly patients, allowing for surgical intervention with favorable postoperative outcomes. However, careful assessment is necessary to avoid underestimating perioperative risks.