# Age Is Not So Important for Risk Stratification in Early Cholecystectomy for Acute Calculous Cholecystitis: A Post-Hoc Analysis of the SPRiMACC Study Database

## TL;DR

This study shows that age alone is not a reliable predictor of complications after early cholecystectomy for acute gallbladder inflammation, suggesting that frailty is a better indicator.

## Contribution

The study demonstrates that age is not an independent risk factor for outcomes after early cholecystectomy when adjusted for physiological scores.

## Key findings

- Age was significant in univariate analysis but not in multivariate analysis for complications and mortality.
- The POSSUM Physiological Score was the only significant predictor of outcomes in multivariate analysis.
- Frailty, not chronological age, should be considered for risk assessment in these patients.

## Abstract

Background and Objectives: Early cholecystectomy (EC) is widely regarded as the first-line treatment for acute calculous cholecystitis (ACC). Current debate centers on the feasibility of EC as an option even for elderly patients. This study aims to determine whether age alone is an independent risk prediction factor for prognosis after EC for ACC. Materials and Methods: This study is a post-hoc analysis of the S.P.Ri.M.A.C.C. WSES prospective international multicenter observational study database, including patients with ACC undergoing EC. Univariate and multivariate analyses were conducted, examining different risk factors for major morbidity and mortality after EC. Results: In the univariate analyses, age was found to be a statistically significant risk factor for both 30-day major complications (p < 0.001) and 30-day mortality (p = 0.003). However, in the multivariate analysis, age alone was not a significant predictor for either outcome, with p-values of 0.419 and 0.094, respectively. The only significant risk factor associated with both 30-day mortality and major morbidity in the multivariate model was the POSSUM Physiological Score (PS). Conclusions: Age alone cannot be considered a reliable risk predictor for a complicated postoperative course after EC in patients with ACC. Frailty, rather than chronological age, should be assessed to predict the outcome of these patients.