Objective <p>To investigate the perioperative outcomes and safety of different completion statuses of laparoscopic cholecystectomy (LC) in elderly patients, providing evidence for surgical risk assessment and perioperative management.</p> Methods <p>A single-center retrospective study was conducted. Clinical data of elderly patients undergoing LC from January 2023 to December 2024 were collected. Patients were categorized into a difficult laparoscopic cholecystectomy (DLC) group or a successfully completed laparoscopic cholecystectomy (SCLC) group based on intraoperative completion status and technical difficulty. Data on operative parameters, postoperative recovery, postoperative complications, and inflammatory markers [tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP)] were analyzed. Independent risk factors for complications were identified via multivariate logistic regression.</p> Results <p>The SCLC group had significantly shorter operative time, less intraoperative blood loss, and attenuated postoperative rises in TNF-α, IL-6, and CRP compared to the DLC group (all <i>P</i> &lt; 0.05). Recovery was faster in the SCLC group, evidenced by earlier time to first flatus and oral intake, shorter length of hospital stay, and lower Visual Analog Scale (VAS) pain scores (all <i>P</i> &lt; 0.05). The overall complication rate was lower in the LC group (7.50% vs. 30.00%, <i>P</i> &lt; 0.05). American Society of Anesthesiologists (ASA) class III and ≥ 2 comorbidities were independent risk factors for complications (<i>P</i> &lt; 0.05).</p> Conclusion <p>LC is generally safe and feasible for elderly patients. However, completion status and intraoperative difficulty are closely associated with perioperative outcomes. Patients with lower surgical difficulty and successful completion experience faster recovery and lower complication rates.</p>