Emergency laparotomy (EL) comprises heterogeneous high-risk procedures with substantial postoperative mortality, reaching 8–18% at 30 days. Although overall 30-day mortality (30-dm) is documented, procedure-specific outcomes remain limited. Defining intervention-level mortality may improve risk stratification and resource allocation. This study aimed to quantify actual 30-dm for the five most frequently performed EL procedures in Romania and examine its correlation with Surgical-Outcome-Risk-Tool (SORT) predicted mortality.
This retrospective multicentre cohort study included adults undergoing EL over two years across four acute care hospitals in North-Eastern Romania, including one tertiary centre. The primary outcome was the correlation between actual and SORT predicted 30-dm for the 5 most common EL procedures. The study followed the TRIPOD checklist. Statistical analysis was performed using GraphPad-Prism v10.6.1.
Among 793 EL patients, 448 (56.4%) underwent the five most frequent procedures: incisional hernia repair with adhesiolysis (n=100;12.61%); actual 30-dm 4.0%; SORT 3.8% (1.7,11.2); R²=0.33, AUC=0.9648, p<0.0001; adhesiolysis (n=107;13.495); actual 30-dm 15.9%; SORT 6.86% (3.1,14.0); R²=0.05, AUC=0.7497, p=0.0117; suture of perforated peptic ulcer (n=88;11.09%), actual 30-dm 20.5%; SORT 5.78% (1.4,14.0); R²=0.24, AUC=0.8516, p<0.0001; Hartmann’s procedure (n=88;11.09%), actual 30-dm 21.6%; SORT 23.06% (12.1,40.3); R²=0.16, AUC=0.7645, p=0.0001; and inguinal hernia repair with adhesiolysis (n=65;8.19%) actual 30-dm mortality 1.5%; SORT 3.21% (0.9,8.2); R²=0.13, p=0.0001. Data is presented as median ± IQR.
SORT demonstrated limited reliability, weak correlation, and persistent misprediction of 30-day mortality across the five most common emergency laparotomy procedures in Romania.
G. Iordache, Sergiu Timofeiov, D. Jardan et al.· British Journal of Surgery· 0 citations
Emergency laparotomy (EL) is a high-risk general surgical procedure, increasingly performed in frail, comorbid populations. Over the past seven decades, multiple risk stratification tools have emerged to quantify perioperative risk, incorporating physiological parameters, comorbidities, and, in some cases, anticipated operative findings. This review synthesises the historical evolution and current utility of these tools in EL, highlighting their roles in shared decision-making, consent, and quality improvement.
Risk prediction in EL has progressed from early physiological scores (ASA, APACHE) to audit-derived models (POSSUM, P-POSSUM), large database-driven calculators (ACS-NSQIP), and EL-specific tools such as NELA, ESAS/PESAS, ESS and CORES. Disease-specific indices (e.g., Mannheim Peritonitis Index) and emerging prognostic markers, including frailty measures and CT-derived body-composition metrics, address limitations of traditional physiological models, particularly in elderly or physiologically vulnerable patients. Tools based solely on preoperative variables support rapid assessment when operative data are unavailable, whereas newer early-mortality scores (e.g., CELIO) may aid proportionality and goals-of-care discussions but require further validation. A chronological table summarises each scoring system’s variables and development timeline.
Risk-adjusted outcomes should replace crude mortality as the benchmark for surgical quality, consent, and institutional comparison. Integrating validated scoring systems with frailty, physiological variables and body composition assessment offers a pragmatic framework for individualised care, especially in older, comorbid patients. This approach supports standardisation, reduces unwarranted variation, and guides future research toward improved calibration and external validation. Clinically, these tools enhance transparency, facilitate multidisciplinary communication, and align surgical decision-making with patient-centred and evidence-based principles.
Marita Georgiou, John T Jenkins, M. Sinclair et al.· British Journal of Surgery· 0 citations