Key result
NELA score persistently overpredicts 30-day mortality across common emergency laparotomy procedures.
Why the study?
Procedure-specific 30-day mortality outcomes after emergency laparotomy are limited, and defining intervention-level mortality may improve risk stratification and resource allocation.
Does NELA-predicted mortality accurately correlate with observed 30-day mortality in adults undergoing emergency laparotomy procedures in Romania?
Cohort (n=793)
Yes
Does NELA-predicted mortality accurately correlate with observed 30-day mortality in adults undergoing emergency laparotomy procedures in Romania?
p-value: p=<0.0001
The NELA risk score persistently overpredicts 30-day mortality for the most common emergency laparotomy procedures in Romanian acute care hospitals, though it maintains a significant predictive correlation.
Observed mortality below NELA prediction in incisional hernia repair; leaves open need for model recalibration in this subgroup.
Background 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. Methods 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. Results 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. Conclusion Despite correlation, NELA persistently overpredicted 30-dm across the five most frequent emergency laparotomy procedures.
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Iordache et al. (2026) conducted a cohort in Emergency laparotomy (n=793). NELA-predicted mortality vs. Actual observed mortality was evaluated on Correlation between actual and NELA 30-day mortality for the 5 most common emergency laparotomy procedures (p=<0.0001). The NELA score persistently overpredicted 30-day mortality across the five most frequent emergency laparotomy procedures, despite demonstrating significant correlation (P<0.0001).
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