Endo I.Takada T.Hwang T.-L.Akazawa K.Mori R.Miura F.Yokoe M.Itoi T.Gomi H.Chen M.-F.Jan Y.-Y.Ker C.-G.HSIU-PO WANGKiriyama S.Wada K.Yamaue H.Miyazaki M.Yamamoto M.2021-01-152021-01-1520171868-6974https://www.scopus.com/inward/record.uri?eid=2-s2.0-85020133825&doi=10.1002%2fjhbp.456&partnerID=40&md5=cc1d41f84ee2d143fbd697ea4cc433achttps://scholars.lib.ntu.edu.tw/handle/123456789/540943Background: Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. Methods: An international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. Results: The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0–3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. Conclusion: Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity. ? 2017 Japanese Society of Hepato-Biliary-Pancreatic SurgeryAcute cholecystitis; Cholecystostomy; Comorbidity; Laparoscopic cholecystectomy[SDGs]SDG3acute cholecystitis; adult; aged; Article; body mass; Charlson Comorbidity Index; cholecystectomy; clinical practice; cohort analysis; comorbidity; conservative treatment; controlled study; disease severity; female; gallbladder drainage; human; Japan; jaundice; major clinical study; male; mortality; multicenter study; neurological complication; observational study; operation duration; prediction; respiratory failure; retrospective study; Taiwan; acute cholecystitis; clinical trial; comparative study; international cooperation; laparoscopic cholecystectomy; middle aged; multivariate analysis; predictive value; procedures; prognosis; risk assessment; severity of illness index; statistical model; survival rate; treatment outcome; very elderly; Aged; Aged, 80 and over; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Cohort Studies; Drainage; Female; Humans; Internationality; Japan; Logistic Models; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate; Taiwan; Treatment Outcomejournal article10.1002/jhbp.456284197412-s2.0-85020133825