Increasing age, septic shock at admission (OR 7.06), and intraoperative vasopressor requirement (OR 6.45) were independently associated with in-hospital mortality (overall 22.3%).
Cohort (n=166)
Does a simplified predictive score based on age, septic shock, and intraoperative vasopressor requirement predict in-hospital mortality in adult patients undergoing emergency surgery for gastrointestinal perforation?
A simplified bedside score based on age, septic shock at admission, and intraoperative vasopressor requirement demonstrates good discrimination (AUC 0.83) for predicting in-hospital mortality in patients undergoing emergency surgery for gastrointestinal perforation.
Background: Gastrointestinal perforation is a life-threatening surgical emergency associated with high morbidity and mortality despite advances in imaging, perioperative care, and emergency surgical management. Early identification of patients at increased risk of death may improve perioperative risk stratification and support personalized clinical decision-making in emergency settings. Methods: We conducted a retrospective observational cohort study including 166 consecutive adult patients undergoing emergency surgery for gastric, duodenal, ileal, colonic, or intraperitoneal rectal perforation between January 2021 and December 2025. Appendiceal perforations, iatrogenic perforations, and anastomotic leaks were excluded. Univariate analysis was performed using appropriate non-parametric and categorical statistical tests. Variables with p < 0.05 were considered for multivariable logistic regression analysis. Postoperative variables potentially influenced by the outcome were excluded to reduce reverse causation and overadjustment bias. Age was analyzed as a continuous variable in regression analysis and subsequently dichotomized at 75 years for development of a simplified bedside score. Results: Overall in-hospital mortality was 22.3% (37/166). Increasing age (OR 1.08 per year increase, 95% CI 1.04–1.12; p < 0.001), septic shock at emergency department admission (OR 7.06, 95% CI 1.29–38.65; p = 0.024), and intraoperative vasopressor requirement (OR 6.45, 95% CI 1.34–31.10; p = 0.020) were independently associated with mortality. A simplified predictive score based on these variables demonstrated good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.83. Conclusions: Mortality following gastrointestinal perforation was associated primarily with early physiological derangement and patient frailty rather than anatomical or technical surgical factors alone. Early identification of high-risk patients may support perioperative risk stratification and patient-centered emergency surgical decision-making. The proposed predictive score should be considered preliminary and hypothesis-generating, as neither internal nor external validation was performed.
Colombo et al. (2026) conducted a cohort in Gastrointestinal perforation (n=166). Risk factors for mortality was evaluated on In-hospital mortality. Increasing age, septic shock at admission (OR 7.06), and intraoperative vasopressor requirement (OR 6.45) were independently associated with in-hospital mortality (overall 22.3%).