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Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and\u2009\u2265\u200965 years. Mortality, postoperative complications, time to operative intervention, post\u2010acute disposition, and length of hospital stay (LOS) were compared between groups. Within the\u2009\u2265\u200965 cohort, comorbidity burden, mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non\u2010operative management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age of 65 or over. Significantly fewer patients\u2009\u2265 65 underwent surgical treatment (37.8% vs. 64.7%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Surgical complications were more frequent in the\u2009\u2265 65 cohort than younger patients, and the mean postoperative LOS was significantly longer. Postoperative mortality was seen in 2.2% of patients\u2009\u2265\u200965 (vs. 0.7%, <jats:italic>p<\/jats:italic>\u2009=\u20090.253). However, operated elderly patients did not differ from non\u2010operated in terms of comorbidity burden, mortality, LOS, or post\u2010discharge rehabilitation need.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Few elderly patients receive surgical treatment for ACCBD. Expectedly, postoperative morbidity, LOS, and the requirement for post\u2010discharge rehabilitation are higher in the elderly than younger patients but do not differ from elderly patients managed non\u2010operatively. With multidisciplinary perioperative optimization, elderly patients may be safely offered optimal treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov (Trial # NCT03610308).<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-021-06052-0","type":"journal-article","created":{"date-parts":[[2021,4,3]],"date-time":"2021-04-03T21:02:37Z","timestamp":1617483757000},"page":"2046-2055","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently\u2014Results and Insights from the ESTES Snapshot Audit"],"prefix":"10.1002","volume":"45","author":[{"given":"Gary A.","family":"Bass","sequence":"first","affiliation":[{"name":"Division of Traumatology, Emergency Surgery &amp; Surgical Critical Care, Penn Presbyterian Medical Center University of Pennsylvania 19104 Philadelphia PA 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