**1. Introduction**

As the world population is aging, there is an increased surgical demand for elderly people. Geriatric surgery is presently a topic of research, as many surgeons acknowledge

**Citation:** Serban, D.; Socea, B.; Balasescu, S.A.; Badiu, C.D.; Tudor, C.; Dascalu, A.M.; Vancea, G.; Spataru, R.I.; Sabau, A.D.; Sabau, D.; et al. Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications. *Medicina* **2021**, *57*, 230. https://doi.org/10.3390/ medicina57030230


Academic Editors: Camelia Diaconu and Johannes Mayr

Received: 31 December 2020 Accepted: 23 February 2021 Published: 2 March 2021

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there are specific features regarding the type of surgery, the duration and intensity of treatment and the significant complications related to the therapeutic approach at advanced ages. The term of "frailty" is often used to describe a vulnerability, a lack of resilience of the elderly to stress and increased demands upon the function of organs or systems. [1–3] Understanding the specific age-related challenges may help improve perioperative care by a multidisciplinary approach [3–5].

Acute cholecystitis is one of the most frequent conditions requiring abdominal surgery in emergencies in elderly people [6]. The current guidelines recommend surgery as soon as possible because evidenced-based clinical studies confirmed that an early treatment reduces the total hospital stay and does not increase the complication or conversion rates [7–11].

Laparoscopic cholecystectomy has become the "gold standard" due to its undeniable advantages in reducing pain and postoperative complications. Together with the development of anesthesia and intensive care skills and techniques, the safety limit for performing laparoscopy has also increased nowadays towards the age of 80–85 years.

In previously published studies on the results of laparoscopic cholecystectomy in the elderly, the age considered as a threshold differs: some studies consider it to be 65 years [12–14], 70 years [15] or 75 years [16], while several studies refer to outcomes of laparoscopic cholecystectomy in extreme ages, such as over 80 years of age [6,17–21]. Most studies compare the conversion rate and the incidence of postoperative complications in groups of young vs. elderly patients. There are limits in terms of reporting the results, as the effect of age is difficult to be dissociated from the presence of comorbidities, which are obviously more common with aging. Other studies [14,22–24] compared the complications of laparoscopic vs. classical cholecystectomy in elderly patients and found better outcomes with a minimally invasive approach.

This study aims to investigate the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. The novelty factor is that age is analyzed in correlation with the anesthetic-surgical systemic risk factors and with the severity of the infectious process. The preoperative variables which correlate best with surgical decisions and postoperative outcomes were analyzed.

#### **2. Materials and Methods**
