TPW 4.01 Correlation Between Observed Mortality and NELA-Predicted 30-Day Mortality Following the Five Most Common Emergency Laparotomy Procedures in Romania: A Retrospective Multicentre Observational Cohort Study

Abstract

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 well 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 National-Emergency-Laparotomy-Audit (NELA) predicted mortality. This retrospective multicentre cohort study included adults undergoing EL over two years across four acute care hospitals in North-Eastern Romania. The primary outcome was the correlation between actual and NELA 30-dm for the 5 most common EL procedures identified after all ELs were collected and analysed. 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%; NELA 30-dm 18.4% (8.2,27.0), R²=0.27, AUC=0.93, p<0.0001; adhesiolysis (n=107;13.49%); actual 30-dm 15.88%, NELA 30-dm 22.4% (12.8,37.1); R²=0.30; AUC=0.8842; p<0.0001; perforated peptic ulcer repair (n=88;20.5%); actual 30-dm 20.45%; NELA 30-dm 22.72% (11.9,51.0); R²=0.46; AUC=0.93 p<0.0001; Hartmann’s procedure (n=88; 21.6%); actual 30-dm 21.59%; NELA 37.64% (24.1,57.3); R²=0.34; p<0.0001, AUC=0.8979; and inguinal hernia repair with adhesiolysis (n=65;1.5%); actual 30-dm 1.5%; NELA 17.09% (12.1,36.1); R²=0.94; p<0.0001. Data are presented as median ± IQR. Despite correlation, NELA persistently overpredicted 30-dm across the five most frequent emergency laparotomy procedures.