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Comparative Evaluation of Mortality Risk Prediction Tools After Emergency Laparotomy.

Sameer Bhat1,2, Campbell Hodges1,3, Shauna O'Brien1

  • 1Department of Surgery, Wellington Regional Hospital, Te Whatu Ora - Capital, Coast and Hutt Valley, Wellington, New Zealand.

ANZ Journal of Surgery
|May 11, 2026
PubMed
Summary
This summary is machine-generated.

The National Emergency Laparotomy Audit prognostic model (P-NELA) most accurately predicts 30-day mortality after emergency laparotomy (EL). The New Zealand Surgical Risk (NZRISK) tool was least reliable in this cohort, highlighting the need for external validation of risk tools.

Keywords:
emergency laparotomymortalityprognosisrisk prediction

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Area of Science:

  • Surgical outcomes research
  • Health services research
  • Predictive analytics in medicine

Background:

  • Accurate pre-operative mortality prediction is crucial for shared decision-making in emergency laparotomy (EL).
  • Comparing prognostic accuracy of existing risk prediction tools is essential for improving patient care.
  • This study evaluates three risk models in a New Zealand cohort.

Purpose of the Study:

  • To compare the prognostic accuracy of the P-NELA, ACS-NSQIP, and NZRISK tools for predicting 30-day mortality after EL.
  • To assess the calibration and accuracy of these risk prediction models in a real-world setting.
  • To provide evidence for selecting the most reliable risk prediction tool for EL patients.

Main Methods:

  • Retrospective cohort study of 312 adult patients undergoing EL between December 2020 and October 2024.
  • Data extracted included demographics, physiology, comorbidities, and imaging for risk calculation.
  • Risk of 30-day mortality assessed using P-NELA, ACS-NSQIP, and NZRISK tools; calibration via R²McF, accuracy via c-statistic.

Main Results:

  • P-NELA demonstrated the highest accuracy (c-statistic = 0.91), followed by ACS-NSQIP (c-statistic = 0.88).
  • NZRISK showed the lowest accuracy (c-statistic = 0.75) compared to P-NELA and ACS-NSQIP.
  • P-NELA was the only well-calibrated tool (R²McF = 0.38), outperforming ACS-NSQIP (R²McF = 0.25) and NZRISK (R²McF = 0.062).

Conclusions:

  • P-NELA is the most accurate and reliable tool for predicting 30-day mortality post-EL in this cohort.
  • NZRISK performed least reliably, indicating potential limitations in its applicability.
  • External validation of risk prediction tools across diverse populations is vital for enhancing peri-operative planning and patient outcomes.