Comparative Analysis of Scoring Systems for Predicting Morbidity and Mortality in Emergency Laparotomy

Emergency laparotomy is associated with high morbidity and mortality rates. Various risk stratification tools, including the National Emergency Laparotomy Audit (NELA) score, Portsmouth-POSSUM (P-POSSUM), American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk calculator, and the Hajibandeh Index, have been developed to predict postoperative outcomes. This study aims to compare the predictive accuracy of these scoring systems in assessing morbidity and mortality in patients undergoing emergency laparotomy.

A prospective observational study was performed at PGIMER, Chandigarh, from January 2023 to June 2024. A total of 510 individuals who underwent emergency laparotomy were included. Preoperative risk evaluation was conducted utilizing NELA, P-POSSUM, ACS-NSQIP, and Hajibandeh Index. Primary outcomes included 30-day mortality, while secondary outcomes assessed surgical site infection (SSI), anastomotic leak, and re-exploration. Diagnostic accuracy, sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve were evaluated.

The NELA score had the greatest predictive accuracy for 30-day mortality (C-statistic: 0.979). The Hajibandeh Index was the most sensitive predictor of surgical site infection and anastomotic leakage, with C-statistics of 0.760 and 0.741, respectively. P-POSSUM demonstrated the greatest specificity in predicting re-exploration.

NELA is the most dependable predictor of mortality, although the Hajibandeh Index excels in predicting postoperative morbidities. P-POSSUM provides better specificity for re-exploration risk. Integrating these tools into clinical practice can optimize patient risk assessment and improve outcomes.