Introduction Choledocholithiasis/cholangitis is a common issue requiring acute intervention. In many centres, this is achieved via Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by interval cholecystectomy. However, ERCP carries risk and is difficult to access, especially in rural centres. Hawkes Bay has been treating these patients with CBDE’s for many years. While there is growing consensus that this is noninferior, it has not yet been proven to be safe in an elderly population. Aim: To establish whether CBDE is a safe procedure in patients over 75 years old. Outcomes included are length of stay, 30-day/90-day/5-year mortality, rehabilitation requirement, complication rate, and median time to procedure. Methods: A retrospective cohort study was completed including all patients over 75 years old who had an acute CBDE between August 2015 and August 2025. Results: Patients who had an acute CBDE had a 3.8% mortality rate at 30 days, 5.7% at 90 days, and 35.8% at 5 years. They had a complication rate of 21.7%, rehabilitation requirement of 4.7%, and median time to procedure of 62.5 hours. Our complication rate is higher than that documented in the literature (Fan et al., 2023), however it seems most studies looking at these disregard medical complications such as arrhythmias and sepsis that we included. We had a similar length of hospital stay to that documented in the literature (Fan et al., 2023). Conclusion: CBDE is a safe and practical alternative to ERCP in patients over 75. It results in lower mortality and shorter hospital stays. It also allows patients to avoid needing an interval cholecystectomy, likely preventing further complications. References Fan, L., Wang, Y., Wu, M., Wu, T., Deng, L., Wang, Y., Liu, L., & An, T. (2023). Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis. BMC Geriatrics, 23(1). https://doi.org/10.1186/s12877-023-04149-w