Key result
NELA, ACS-NSQIP, and SORT models accurately predict 30-day mortality after emergency laparotomy.
Why the study?
Validation and implementation of 30-day mortality risk models after emergency laparotomy remain limited in Eastern European healthcare systems.
Does NELA, ACS-NSQIP, and SORT predicted 30-day mortality accurately correlate with observed mortality in adults undergoing emergency laparotomy in Romania?
Cohort (n=793)
Yes
Does NELA, ACS-NSQIP, and SORT predicted 30-day mortality accurately correlate with observed mortality in adults undergoing emergency laparotomy in Romania?
p-value: p=<0.0001
Established surgical risk models show strong discrimination but variable calibration for predicting 30-day mortality following emergency laparotomy in an Eastern European healthcare setting.
NELA shows strong discrimination for 30-day mortality; supports validation efforts but leaves open need for prospective confirmation before routine use.
Background Emergency laparotomy (EL) is associated with substantial postoperative mortality, with reported 30-day mortality (30-dm) rates of 8–18% in unselected adults. Although 30-dm risk models are widely used, their validation and implementation in Eastern European healthcare systems remain limited. This study evaluated the correlation between observed 30-dm and that predicted by the National-Emergency-Laparotomy-Audit (NELA), the American-College-of-Surgeons-National-Surgical-Quality-Improvement-Program (ACS-NSQIP), and the Surgical-Outcome-Risk-Tool (SORT) in Romania. Methods This was a retrospective, multicentre cohort study spanning 2 years and included all adults ≥18 years undergoing EL at 4 acute care hospitals in North Eastern Romania, including one tertiary centre. The primary outcome was defined as the correlation between actual 30-dm and NELA, ACS-NSQIP or SORT predicted 30-dm. To strengthen transparency and reproducibility, the study adhered to the TRIPOD checklist. Statistical analysis was performed using GraphPad Prism v10.6.1. Results 793 cases were analysed. Median age was 69 (57,77) years, with M/F ratio of 1.27, ASA grade 3 (3,4), Clinical-Frailty-Score 5 (4,6), and Charlson Comorbidity Index 5 (3,7). Actual 30-dm was 21.68%. Predicted and correlated mortality estimates were: NELA 31.4% (16.6,56.1), R²=0.38, AUC=0.8968, p<0.0001; ACS-NSQIP unadjusted 8.00% (1.5,24.8), R²=0.49, AUC=0.9226, p<0.0001; ACS-NSQIP risk somewhat higher 19.0% (9.4,29.6), R²=0.43, AUC=0.8992, p<0.0001; ACS-NSQIP risk significantly higher 26.9% (12.7,34.9), R²=0.32, AUC=0.8474, p<0.0001; and SORT 10.1% (3.8,26.1), R²=0.21, AUC=0.8139, p<0.0001. Data are presented as median±IQR. Conclusion All models correlated with 30-day mortality, yet validation showed strong discrimination alongside markedly variable calibration.
No takes yet. Share an insight, caveat, or question.
Iordache et al. (2026) conducted a cohort in Emergency laparotomy (n=793). NELA, ACS-NSQIP, and SORT predicted mortality models was evaluated on Correlation between actual 30-day mortality and NELA, ACS-NSQIP, or SORT predicted 30-day mortality (p=<0.0001). NELA, ACS-NSQIP, and SORT risk models significantly correlated with 30-day mortality after emergency laparotomy (AUCs ranging from 0.8139 to 0.9226, p<0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: