NELA, P-POSSUM, and Paraspinal Muscle Index in risk stratification of elderly patients undergoing emergency laparotomy.
Low nutritional index predicted mortality after emergency laparotomy in elderly patients
NELA, P-POSSUM, and Paraspinal Muscle Index in risk stratification of elderly patients undergoing emergency laparotomy.
Emergency laparotomy in older adults is associated with substantial morbidity and mortality, necessitating accurate and rapid preoperative risk stratification.
The aim of this study was to evaluate the comparative performance of computed tomography-derived morphometric indices, established risk models (National Emergency Laparotomy Audit and P-POSSUM), and the Prognostic Nutritional Index (Prognostic Nutritional Index) in predicting postoperative morbidity and in-hospital mortality in elderly patients undergoing emergency laparotomy.
This prospective, single-center cohort study included patients aged ≥65 years who underwent emergency laparotomy for acute abdomen between 2022 and 2023.
predicted mortality moderately well, above 0.7 is meaningful, 1.0 perfect
Major postoperative complications (Clavien-Dindo ≥ 3) and in-hospital mortality were strongly associated with nutritional status.
Lower Prognostic Nutritional Index values were significantly associated with major complications, life-threatening complications (Clavien-Dindo ≥ 4), and in-hospital mortality.
In contrast, Paraspinal Muscle Index and Fat-to-Muscle Ratio showed no significant association with postoperative complication severity (Paraspinal Muscle Index: p = 0.479; Fat-to-Muscle Ratio: p = 0.614) or mortality and did not correlate with clinical risk scores (all p > 0.05).
In elderly patients undergoing emergency laparotomy, established clinical risk scores and nutritional status were strongly associated with postoperative outcomes, whereas computed tomography-derived paraspinal muscle quantity indices did not reflect perioperative risk or complication severity.
Future predictive models should integrate nutritional indices, muscle quality measures, functional frailty, and acute physiological parameters to improve risk stratification in elderly emergency surgery.