Abstract Background Gallstones commonly cause emergency surgical admission in older adults and are frequently associated with complications. Although cholecystectomy is recommended in the general population, decision-making is complicated by increased comorbidity and frailty in older patients. Methods Trainee-led prospective multicentre cohort across nine NHS hospitals. Consecutive emergency admissions in patients aged ≥ 70 years with radiologically confirmed gallstone disease were recruited (November 2022–March 2024). Data were collected at baseline, 30-days and 1-year, including Gastrointestinal Quality of Life Index (GIQLI) scores. Results Of 194 patients , 36 (18.6%) underwent emergency cholecystectomy, with 158 (81.4%) managed non-operatively at initial presentation. The non-operative group had greater comorbidity burden and frailty. All emergency operations were started laparoscopically (one conversion) with no major complications; median length of stay was similar (7 vs 5 days, p = 0.105). Gallstone-related readmission at 1-year was higher after non-operative management (23.0% vs 2.9%, p = 0.024); non-biliary readmissions were similar. One-year mortality was 12.4% vs 0% ( p = 0.06). Baseline GIQLI was similar. At 30-days, emergency cholecystectomy was associated with the greatest difference in GIQLI score compared to the non-operative group (p ≤ 0.007). At 1-year, GIQLI remained higher after emergency cholecystectomy (123.8 vs 115.6, p = 0.039). Forty-three patients had undergone interval cholecystectomy by 1-year. Conclusion Emergency cholecystectomy in older patients deemed suitable for surgery is associated with reduced gallstone-related re-admissions at 1-year and higher QoL scores. These findings support consideration of surgery in appropriately selected older patients and further randomised research in this higher risk group.
Fairclough et al. (Sun,) studied this question.