Surgeon-perceived intraoperative complexity is associated with early adverse outcomes after major emergency abdominal surgery: a prospective cohort study
In brief
Each complexity point linked to 20% higher reoperation risk after emergency surgery
In a single-center study of 411 patients, each one-point increase in surgeons' complexity ratings was associated with a 20% higher rate of unplanned reoperation within 30 days; reoperations occurred in 15% of patients overall. Higher ratings were also associated with longer hospital stays, more complications, and greater mortality, but the assessment needs external validation before it can guide care.
- Journal
- European journal of trauma and emergency surgery : official publication of the European Trauma Society (Q1)
- Published
- 8 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Lasse Rehné Jensen, Thea Helene Degett, Trygve Ulvund Solstad, Lukas Schak Nielsen, Dunja Kokotovic, Thomas Korgaard Jensen, et al.
- PMID
- 42848062
- DOI
- 10.1007/s00068-026-03355-6
Why clinicians should know about it
- Picked for Surgery (paper of the day, 9 October 2026): Prospective cohort linking intra‑operative complexity to emergency abdominal outcomes
Abstract
BACKGROUND: Intraoperative complexity in major emergency abdominal surgery lacks a standardized definition and is rarely quantified prospectively. Whether surgeon-perceived intraoperative complexity is associated with short-term postoperative outcomes remains unknown. METHODS: In this single-center prospective cohort study, 411 patients undergoing major emergency abdominal surgery were included. Immediately after surgery, the operating surgeon rated perceived intraoperative complexity on a 0-10 scale. The association between surgeon-perceived intraoperative complexity and the primary outcome, 30-day unplanned reoperation, was investigated using Fine-Gray regression. The model was adjusted for age, sex, body mass index, performance status, and intraoperative pathology. Secondary outcomes were 30-day mortality, length of stay, and Comprehensive Complication Index. RESULTS: Unplanned reoperation occurred in 15% and 30-day mortality in 11%. Higher surgeon-perceived intraoperative complexity was associated with reoperation (sHR 1.20 per point; 95% CI 1.08-1.34). Complexity was also associated with prolonged LOS (β 1.47 days per unit increase; 95% CI 0.93-2.01), higher CCI category (OR 1.24 per unit increase; 95% CI 1.14-1.35), and increased 30-day mortality (OR 1.25; 95% CI 1.07-1.45). CONCLUSION: Surgeon-perceived intraoperative complexity was associated with reoperation, morbidity, and 30-day mortality after major emergency abdominal surgery. These findings suggest that the operating surgeon's assessment may capture clinically meaningful prognostic information beyond conventional baseline risk factors. External validation and evaluation of inter-rater reproducibility are needed before clinical implementation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.