Timing matters in acute calculous cholecystitis, particularly for high-risk patients.

• Percutaneous cholecystostomy within 48 hours leads to a shorter stay: 7 days vs. 13 days (p<0.001).
• Mortality drops significantly when performed early: 5.9% at 90 days vs. 22.6% (p=0.037).
• Delayed procedures linked to 4.80 times higher odds of longer hospital stays.

Early intervention can significantly improve outcomes and reduce complications, urging surgeons to act swiftly in high-risk cases.

• CCI score ≥7 increases in-hospital mortality risk by 13.68 times (p=0.047).