MANagement of Gallstone disease in the Older patient (MANGO): Clinical and Quality of Life Outcomes from a Prospective Multicentre Cohort Study

Background: Gallstones commonly cause emergency surgical admission in older adults and are frequently associated with complications. Although cholecystectomy is recommended in the general population, decision-making is complicated by increased comorbidity and frailty in older patients. Methods: Trainee-led prospective multicentre cohort across nine NHS hospitals. Consecutive emergency admissions in patients aged ≥70 years with radiologically confirmed gallstone disease were recruited (November 2022–March 2024). Data were collected at baseline, 30-days and 1-year, including Gastrointestinal Quality of Life Index (GIQLI) scores. Results: Of 194 patients , 158 (81.4%) were managed non-operatively and 36 (18.6%) underwent emergency cholecystectomy. The non-operative group had greater comorbidity burden and frailty. All emergency operations were started laparoscopically (one conversion) with no major complications; median length of stay was similar (7 vs 5 days, p=0.105). Gallstone-related readmission at 1-year was higher after non-operative management (23.0% vs 2.9%, p=0.024); non-biliary readmissions were similar. One-year mortality was 12.4% vs 0% (p=0.06). Forty-three patients underwent interval cholecystectomy by 1-year. Baseline GIQLI was similar. At 30-days, emergency cholecystectomy was associated with higher GIQLI across domains (p≤0.007). At 1-year, GIQLI remained higher after emergency cholecystectomy (123.8 vs 115.6, p=0.039) but was comparable when interval cholecystectomy patients were included. Conclusion: Emergency cholecystectomy in older patients deemed suitable for surgery is associated with improved QoL scores and reduced gallstone-related re-admissions at 1-year. Interval surgery achieved comparable QoL outcomes. These findings support consideration of surgery in appropriately selected older patients.