Key result
Preoperative ASA ≥III linked to ~467% higher 30-day mortality risk after emergency general surgery.
Why the study?
Emergency general surgery carries substantial morbidity and mortality, but prospective data identifying determinants of adverse outcomes in the Indian context remain limited.
What are the independent predictors of 30-day postoperative morbidity and mortality in adult patients undergoing emergency general surgery?
Cohort (n=385)
No
What are the independent predictors of 30-day postoperative morbidity and mortality in adult patients undergoing emergency general surgery?
In a resource-limited setting, modifiable risk factors such as delayed presentation, sepsis, and preoperative hypotension are significant independent predictors of 30-day morbidity and mortality following emergency general surgery.
High ASA status associated with greater 30-day morbidity; leaves open value of targeted perioperative interventions pending RCTs.
Background: Emergency general surgery (EGS) carries substantial morbidity and mortality, particularly in low- and middle-income countries. Despite the burden, prospective data identifying the determinants of adverse outcomes in the Indian context remain limited. With this aim, the study was conducted to identify the independent predictors of 30-day postoperative morbidity and mortality in patients undergoing EGS at a tertiary care teaching hospital in India. Methods: This prospective observational cohort study enrolled consecutive adult patients (t18 years) undergoing emergency general surgical procedures over 12 months (January–December 2025). The primary outcomes were 30-day postoperative morbidity (defined as any Clavien-Dindo grade -II complication) and 30-day mortality. Demographic, clinical, laboratory, and operative variables were collected. Univariate analysis identified the factors associated with outcomes, followed by multivariable logistic regression to determine independent predictors. Results: Of 385 patients enrolled, 372 completed a 30-day follow-up. Mean age was 48.3 ± 16.8 years; 68.5% were male. Common diagnoses included perforation peritonitis (38.2%), intestinal obstruction (24.5%), and acute appendicitis (18.3%). Overall 30-day morbidity was 42.7% ( n = 159) and mortality was 8.9% ( n = 33). Independent predictors of morbidity were: ASA ditys (adjusted odds ratios [aOR] 3.42, 95% confidence interval [CI] 2.08–5.63), sepsis at admission (aOR 2.89, 95% CI 1.74–4.81), delayed presentation >48 h (aOR 2.34, 95% CI 1.42–3.86), and age >60 years (aOR 1.98, 95% CI 1.15–3.41). Independent predictors of mortality were: ASA lIII (aOR 5.67, 95% CI 2.34–13.72), sepsis at admission (aOR 4.23, 95% CI 1.68–10.65), preoperative hypotension (aOR 3.78, 95% CI 1.52–9.39), and generalized peritonitis (aOR 2.91, 95% CI 1.18–7.16). Conclusion: Modifiable risk factors including delayed presentation, sepsis, and preoperative hypotension significantly predict the adverse outcomes. Early recognition, timely referral, and protocolized resuscitation may improve EGS outcomes in the resource-limited settings.
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Yadav et al. (2026) conducted a cohort in Emergency general surgery (n=385). Emergency general surgery was evaluated on 30-day postoperative morbidity (any Clavien-Dindo grade ≥II complication) and 30-day mortality. Preoperative risk factors including ASA ≥III (aOR 5.67; 95% CI 2.34-13.72) and sepsis (aOR 4.23) independently predicted 30-day mortality after emergency general surgery.
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