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Give good article about mortality predictors in emergency exploratory patient indexed in pubmed

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"exploratory laparotomy"[MeSH Terms] AND "mortality"[MeSH Terms] AND "predictors"

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"emergency laparotomy"[MeSH Terms] AND "mortality" AND "risk factors"

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emergency laparotomy mortality predictors

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emergency surgery mortality risk score prediction

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Here is a curated, well-indexed selection of PubMed articles on mortality predictors in emergency exploratory laparotomy patients, organized by evidence level:

Mortality Predictors in Emergency (Exploratory) Laparotomy - PubMed Articles

Highest-Quality Evidence

[Systematic Review + Meta-Analysis . Tier 2 . 2020] Barazanchi et al. - Risk factors for mortality after emergency laparotomy: scoping systematic review. ANZ Journal of Surgery | PMID: 32580245 | DOI: 10.1111/ans.16082
This is the most directly relevant high-level evidence article. Screened 6,648 articles, included 22 studies with 157,728 patients. Combined 30-day mortality was 13%. Key preoperative mortality predictors identified:
  • Age
  • ASA status
  • Preoperative sepsis
  • Dependency status
  • Active cancer
  • Comorbidities
  • Renal derangement, hypoalbuminaemia, CBC abnormalities
Notably, delay to surgery and diabetes did NOT independently predict mortality. Higher BMI was protective. The authors call for prospective research into frailty and nutritional status as emerging risk factors.
[Systematic Review + Meta-Analysis . Tier 1 . 2022] Kennedy et al. - Frailty and emergency abdominal surgery: A systematic review and meta-analysis. The Surgeon | PMID: 34980559 | DOI: 10.1016/j.surge.2021.11.009
Patients >=65 years account for ~55% of emergent operations but 75% of postoperative mortality. Key findings:
  • Frailty prevalence: 30.8% among emergency abdominal surgery patients
  • All-cause mortality: 15.68% overall; 24.7% among frail patients
  • Frailty associated with mortality OR 4.3 (95% CI 2.25-8.19)
  • Also associated with complications, prolonged LOS, and loss of independence
Conclusion: frailty scoring should be integrated into acute surgical assessment as a core mortality predictor.

Comparative Score Validation

[Comparative Study . 2026] Hassan et al. - 30-Day mortality risk predictors for emergency laparotomy: a comparative study. Annals of the Royal College of Surgeons of England | PMID: 41521931 | DOI: 10.1308/rcsann.2025.0075
Compared four risk calculators (NELA, P-POSSUM, ACS-NSQIP, SORT) in 227 patients. Results:
  • NELA had the highest sensitivity (73.3%) for identifying patients who died
  • ACS-NSQIP had the highest specificity (88.7%)
  • AUC: NELA = 0.869, ACS-NSQIP = 0.877
  • Average predicted 30-day mortality for those who died: NELA 25.8%, P-POSSUM 39.6%, ACS-NSQIP 17.9%, SORT 15.7%
Conclusion: NELA demonstrated the best overall performance for mortality prediction in emergency laparotomy.
[Single-Centre Cohort . 2023] Darbyshire et al. - Novel predictors of mortality in emergency bowel surgery. Anaesthesia | PMID: 36723442 | DOI: 10.1111/anae.15966
1,508 patients from NELA database. Evaluated NEWS, Lab Decision Tree Early Warning Score, and Hospital Frailty Risk Score. Key findings:
  • Individual novel scores had c-statistics of 0.699-0.740
  • A combined logistic model (age + NEWS + Lab-DTEWS + HFRS) achieved c-statistic 0.827
  • NELA score still outperformed all (c-statistic 0.861)
  • NEWS >=4 was associated with >10% overall mortality

Population-Specific Studies (Elderly / Low-Resource Settings)

[Multicentre Retrospective Cohort . 2021] Hajibandeh et al. - Mortality predictors in octogenarians undergoing emergency laparotomy. Langenbeck's Archives of Surgery | PMID: 33825046 | DOI: 10.1007/s00423-021-02168-y
523 octogenarians. Mortality was striking:
  • 30-day mortality: 21.8%
  • In-hospital mortality: 22.6%
  • 1-year mortality: 40.2%
Independent predictors of 30-day mortality:
  • ASA status (OR 2.49)
  • Peritoneal contamination (OR 2.00)
Predictors of 1-year mortality additionally included malignancy (OR 2.06).
[Multicenter Prospective Cohort . 2025] Kagimu et al. - Predictors of morbidity and mortality among elderly patients undergoing emergency exploratory laparotomy in Uganda. Perioperative Medicine | PMID: 41299740 | DOI: 10.1186/s13741-025-00631-8
86 elderly patients (>=65 years) in a low-resource African setting. Mortality: 10.5%. Independent predictors of mortality on multivariate analysis:
  • Delayed presentation to hospital
  • Blood transfusion requirement
Complications (25.6%) predicted by age >80, diabetes/hypertension, and bowel perforation.
[Multicenter Prospective Cohort . 2023] Hailu et al. - Perioperative mortality and its predictors in emergency laparotomy in Ethiopia. Annals of Medicine and Surgery | PMID: 37113892 | DOI: 10.1097/MS9.0000000000000437
Postoperative complication rate: 39.3%, in-hospital mortality: 8.4%. Independent mortality predictors:
  • Age >65 (AOR 8.46)
  • Intraoperative complications (AOR 7.26)
  • Postoperative ICU admission (AOR 8.5)

Machine Learning Approach

[Retrospective Cohort . 2022] Smith et al. - Using Machine Learning to Establish Predictors of Mortality in Emergency Laparotomy. World Journal of Surgery | PMID: 34704147 | DOI: 10.1007/s00268-021-06360-5
1,461 patients; mortality 12.4%. Decision tree analysis identified:
  • Patient factors: age >=46 years, active TB, hypertension, >=1 comorbidity, malignancy
  • Physiological factors: base excess < -6.8 mmol/L, serum urea >7.0 mmol/L
  • Time factor: waiting time from admission to operation
  • In enteric breach patients: age <46 + Shock Index >1.0 = high-risk
  • In non-enteric breach patients: operative duration >90 min + urea >7 mmol/L = high-risk

Summary of Common Mortality Predictors Across Studies

PredictorStrength of Evidence
ASA statusVery strong (multiple studies)
Age >65 / >80Very strong (multiple studies)
FrailtyStrong (meta-analysis OR 4.3)
Preoperative sepsisStrong (systematic review)
Renal dysfunction / elevated ureaStrong
HypoalbuminaemiaStrong
Peritoneal contaminationModerate-strong
Active malignancyModerate
Intraoperative complicationsModerate
Delayed presentation/surgeryVariable (delay to operation not significant in one SR; delayed hospital presentation significant in another)
Shock Index / base excessModerate (machine learning study)
Blood transfusion requirementModerate (low-resource setting)
The NELA score currently performs best among established tools for preoperative 30-day mortality prediction (AUC ~0.87).
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