**5. Conclusions**

The present study showed that laparoscopic cholecystectomy is the most used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgical related complications and a reduced incidence of acute cardiovascular events in the early postoperative period. On the other hand, patients with a higher ASA grade and severe forms of TG 13/18 were more likely to undergo open surgery.

Laparoscopic cholecystectomy can be safely performed in elderly and extremely elderly people, but the risk of severe postoperative cardiovascular complications is slightly higher. Careful perioperative care of the vascular, hemodynamic and respiratory status should be provided in order to prevent these adverse events in the elderly. The degree of systemic inflammation and sepsis was one of the main factors that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with both increased surgical related and cardiovascular postoperative morbidity, while a previous history of stroke and chronic renal insufficiency are correlated with a high risk of cardiovascular complications. CCI, ASA PS and the incidence of severe forms increase with age, also leading to slightly more complications. However, age alone should not be the contraindication for laparoscopic cholecystectomy. With adequate perioperative care, the elderly have much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.

**Author Contributions:** Conceptualization, S.A.B., B.S. and D.S. (Dragos Serban); methodology, S.A.B., C.T. and A.M.D.; formal analysis C.T., D.S. (Dan Sabau); investigation, S.A.B., G.V., A.M.D., R.I.S.; resources, D.S. (Dragos Serban); data curation R.I.S., C.T. and C.D.B.; writing—original draft preparation, S.A.B., A.M.D., D.S. (Dragos Serban), C.D.B.; writing—review and editing, B.S., C.D.B., G.V., D.S. (Dan Sabau), A.D.S.; visualization, S.A.B., B.S.; supervision, D.S. (Dragos Serban); project administration, D.S. (Dragos Serban). All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** Ethical review and approval were waived for this study, since this is the retrospective study, and the data were collected from observation charts and postoperative note.

**Informed Consent Statement:** Patient consent was waived since this is the retrospective study.

**Data Availability Statement:** Not applicable.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**

