HIGH-RISK PATIENT IN EMERGENCY ABDOMINAL SURGERY: PREDICTORS OF MORTALITY AND POSTOPERATIVE COMPLICATIONS

Abstract

Emergency abdominal surgery combines acute physiological instability with limited time for optimisation, making it one of the highest-mortality settings in surgical practice; thirty-day mortality after emergency laparotomy is usually between ten and fifteen percent and reaches about one fifth of frail older patients. This narrative, critical and descriptive review analysed the predictors of mortality and postoperative complications in the high-risk patient undergoing emergency abdominal surgery, as well as risk stratification tools and their implications for practice. Prognostic factors such as age, frailty assessed by the Clinical Frailty Scale, sepsis, hyperlactataemia, anaemia and renal dysfunction were discussed, alongside the comparative performance of POSSUM, P-POSSUM, NELA, ACS-NSQIP and SORT, emphasising the distinction between discrimination and calibration. The concept of failure to rescue, the relevance of time to source control, and therapeutic proportionality in extreme risk were examined in depth. It is concluded that prediction alone is insufficient: outcomes depend on local calibration of scores, on the institutional capacity to recognise and treat complications, and on the organisation of perioperative care.