No Stone Left Unturned: Emergency Biliary Surgery in Frail Older Adults

Introduction

• Gallstone related pathology accounts for a significant proportion of acute general surgery admissions. Attitudes and practices for surgical intervention in the cohort of older adults living with frailty, presenting acutely with gallstone related pathology, in particular CBD stones, varies across surgical units. We report outcomes from a single centre with established expertise and practice of single-stage cholecystectomy with bile duct exploration. 

Methods

• Retrospective cohort study of patients aged ≥80 undergoing emergency cholecystectomy at a busy DGH throughout 2025. Cases involving duct exploration without cholecystectomy were excluded (n=2). CFS were noted from the documentation. Primary outcomes were successful single-stage bile duct clearance, 30-day morbidity (Clavien-Dindo), and mortality, and length of stay (LOS). 

Results

• 30 patients were included. Median age was 84 years (range 80-92), 53% were female. 17% were robotically assisted, the rest were performed laparoscopically. The majority were living with some degree of frailty, 28% were fit or managing well (CFS 2-3), 59% were living with very mild or mild frailty (CFS 4-5), and 13% with moderate frailty (CFS 6). 17 patients required bile duct exploration, and 16 of those achieved clearance, 1 required post-operative ERCP. There were no 30-day deaths, one patient died at 45 days. Median LOS for all patients was 7 days. Overall 30-day complication rate was 23%.

Conclusion

• In a unit with appropriate expertise and departmental ethos in delivering optimal care for selected frail older adults, it is safe and feasible to achieve cholecystectomy and bile duct clearance as a single-stage procedure, potentially avoiding the morbidity and wait associated with a staged ERCP