Aims: Rates of surgery for symptomatic gallstone disease often diminish with advancing age. Frailty may explain the differences in health status at a given age in the older population. This study aims to define the outcomes in older people admitted to an Acute Surgical Unit with acute biliary pathology, and to explore whether frailty influences treatment decisions in this patient population.

Methods: This was a retrospective cohort study undertaken at Logan hospital, a secondary teaching hospital in metropolitan Brisbane, Australia. Patients aged ≥65 years admitted to the ASU with gallstone disease between the 1st February 2019 and 31st January 2021 were included. The primary outcome measure was the treatment decision made. Other outcome measures included the patient's length of stay, ICU admission, discharge destination and 90-day mortality.

Results: One hundred and seventy-four admissions met inclusion criteria over the study period, comprising of 159 patients. The median age was 74 years. Patients undergoing intervention were more likely to be younger (p = 0.03), have a lower CFS score (p = 0.046) and fewer comorbidities (p < 0.001). Patients with a lower CFS score and fewer than 3 co-morbidities were also shown to have a shorter hospital length of stay.

Conclusions: Frailly affects surgical decision making in elderly patients presenting with gallstone disease. Other factors which correlate with favourable outcomes could be used to create a scoring system to guide surgical decision making. Further research is required to determine how to appropriately select older patients who would benefit from surgical intervention.