Predictors of Adverse Postoperative Outcomes Following Emergency Laparotomy: A Prospective Observational Study

Abstract

Background: Emergency laparotomy remains one of the most frequently performed procedures in general surgery and is associated with significant postoperative morbidity and mortality. Identifying clinical and biochemical predictors of adverse outcomes may help in early risk stratification and improved perioperative management. This study aimed to evaluate predictors of postoperative morbidity and mortality in patients undergoing emergency laparotomy.

Methods: This prospective observational study was conducted over a period of 18 months in a tertiary care hospital and included 150 patients undergoing emergency laparotomy. Patients aged >18 years undergoing surgery for acute abdominal conditions were included. Demographic variables, comorbidities, preoperative laboratory parameters, operative findings, and perioperative variables were recorded. Postoperative outcomes including complications and mortality within 30 days were analyzed. Statistical analysis was performed using Chi-square test, Student’s t-test, and multivariate logistic regression analysis. A p value <0.05 was considered statistically significant.

Results: A total of 150 patients underwent emergency laparotomy (mean age 48.6 ± 16.3 years; 62.7% males). The main indications were perforation peritonitis (46.7%), intestinal obstruction (30.0%), and trauma (14.0%). Overall morbidity occurred in 63 patients (42.0%), while 30-day mortality was 12.0% (n = 18). Common complications included surgical site infection (18.0%), respiratory complications (10.0%), intra-abdominal sepsis (7.3%), and anastomotic leak (6.7%).Univariate analysis showed significant associations between morbidity and age >60 years (χ² = 8.41, p = 0.003), albumin <3.5 g/dL (χ² = 10.72, p = 0.001), ASA ≥III (χ² = 12.36, p <0.001), delay to surgery >24 h (χ² = 6.18, p = 0.013), and operative duration >2 h (t = 2.64, p = 0.009). Multivariate analysis identified ASA ≥III (OR 4.08) and hypoalbuminemia (OR 3.21) as independent predictors. Mortality correlated with age >60 years (p = 0.007), preoperative sepsis (p = 0.003), and albumin <3.0 g/dL (p = 0.001). Albumin predicted mortality (ROC AUC 0.78; sensitivity 72%, specificity 74%).

Conclusion: Emergency laparotomy is associated with considerable postoperative morbidity and mortality. Advanced age, higher ASA score, hypoalbuminemia, delayed surgical intervention, and preoperative sepsis significantly increase the risk of adverse outcomes. Early identification and optimization of these risk factors may help improve surgical outcomes in patients undergoing emergency laparotomy.