Objective:Comparison of early cholecystectomy (EC) and delayed cholecystectomy (DC) after percutaneous transhepatic gallbladder drainage (PTGD) for over 80-year-old patients with acute cholecystitis.Methods:Clinical data of 297 over-80-year-old patients of with acute cholecystitis undergoing surgery in Shidong Hospital Affiliated to the University of Shanghai for Science and Technology from January 2016 to January 2023 were retrospectively analyzed, including 123 males and 174 females, aged (86.1±5.2) years. There were 176 cases in EC group and 121 in PTGD-DC group. Demographic data and perioperative outcomes were compared between the groups, including gender, age, ASA score, lab test, grades of acute cholecystitis, symptom, time before EC or PTGD, intraoperative blood loss, conversion, respiratory disfunction, gangrenous cholecystitis, abdominal drainage time, postoperative complication, hospital stay, intensive care time.Results:The baseline characteristics were similar between EC and PTGD-DC groups, including demographics, ASA score, grades of acute cholecystitis, white blood cell counting, platelet counting, level of serum procalcitonin, time before EC or PTGD, and percentage of comorbidity. Compared to PTGD-DC group, Patients in DC group experienced more intraoperative blood loss (118±62 vs 32±31ml], longer operative time (135±43 vs 61±31) min], higher incidence of gangrenouscholecystitis [23.2%(41/176) vs 9.9%(12/121)], more respiratory support [16.5%(29/176) vs 11.6%(14/121)], more conversion to open surgery [22.7%(40/176) vs 9.1%(11/121)], longer postoperative abdominal drainage time (9.1±2.6 vs 3.8±2.3d], longer hospitalization (8.2±3.1 vs 6.1±2.2 d], longer intensive care (9.0±0.3 vs 4.6±0.2 h] (all P<0.05). More complications were observed in EC group, such as bile leakage, postoperative bleeding, unscheduled reoperation, bile duct injury (all P<0.05). Conclusion:PTGD and DC could lower the perioperative risk of elderly patients with acute cholecystitis.